04488 (RPL)c6ht 4 0 4 4 8 8
P.O. BOX 1504
Building
78-105 Cn 54-301 Oak Hill LA QUINTACAL CALIFORNIAFORN
Address 92253
Addr
Owner
BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address Same, A.P. Number PGA West
City Zip Tel.
Legal Description
Contractor ��
Project Description -
Address
68-465 Perez Road
City lZip Tel.
State Lic.
& Classif.
Ci
Li
Arch., Engr.,
Designer
Address
Tel.
%?
No.
ty
c. #
City I Zip I State
Li c.
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm•th'at I am'licensed$Ader provisions.of`Chapter 9 (commencing with Section
7000) of Division 3, of•4fieBusiness and Professions'Code„and,my1icenseois in full force and,-+,
effect. y. / .r 1 y.
_SIGNATURE - DATE
OWNER -BUILDER DECLARATION
I.hereby affirm that I am exempt from the Contractor's License Law for the following
reason:.( ec.:.7031:5;Business and Pro/essions Code: Any city or county which requires a
p'erinit, to. cdnstruot, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the: applicant for such permit to file a signed statement that he is licensed pursuant to
tlie',p. visions- of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3•of. the Business and Professions Code, or that. he is exempt therefrom, and the basis
for” the 'alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects •the applicant to a civil penalty of not more than live hundred dollars ($500).
O I, as owner of the property, or my employees with wages as their sole compensation, will
do the.work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he, did not build or improve for the purpose of sale.)
O 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of .property who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's.Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hundred dollars (8100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
=any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is Issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Sq. Ft. .
Size
No. Dw.
Units
New O Add O Alter ❑ Repair O Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. ��� • d�
Const. o u •
Mech. �� • �
Electrical n 1,0 . i7 V
Plumbing • '�+UIQ
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS pyqq,�,,pp��i�yyyy ;(kyr r{ 6y [
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE -INSPECTOR
WHITE -FINANCE PINK .APPLICANT, GREEN BUILDING, GOLDENROD -.ASSESSOR'S OFFICE .HARD
�y
Issued by: Date Permit
Validated by:
Validation:
:COPY -<FILE
CONSTRUCTION ESTIMATE
, , NO. ELECTRICAL FEES
NO. PLUMBING FEES
$
UNITS
SLAB GRADE
IST FL SO Fl rp
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
YARD SPKLR SYSTEM
2ND FL SO FT. a
DUCT WORK
ROCK STORAGE
FOUND. REINF.
MOBILEHOME SVC.
BAR SINK
POR SO FT. a
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT.
GROUT
WATER HEATER
SERVICE
FINAL INSP.
DRAINAGE PIPING
CAR P. SO FT. 6
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
DRINKING FOUNTAIN
WALL SO. F1'.
FINAL INSP.
FRAMING
FINAL INSP.
URINAL
SO. FT. 4i
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used. as property tax valuation
VENTILATION
FLOOR DRAIN
MECHANICAL FEES
FIRE ZONE ROOFING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISHI
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID 114 c
SEWAGE DISPOSAL
'
SO.FT.GAR rg 3'4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.F:EE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR*
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
'
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
-
GARDEN WALL FINAL