03931 (RPL)Building
Address
Owner
Address
City
55-319 Oak Hill
Roberta Vasi
48- Saddlobac k Road
Zip ITel
Contractor
Wick Coathran Pool.. many
Address
4511 S o Sunny hunts Roafl
City lZip ITel
State Lic. I City
& Classif. 312674 Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (co
7000) of Division 3 of theB'usiness and•Professidns Code, and my lic
effect. , �^ rf
P.O. BOX 1504
78-105 CALLE ESTADO
,LA,QU L NTA, ,CACI FOR N IA,92253
BUILDING:'TYPE CONST. OCC. GRP.
,P.,;N.umbe.r PGA Rost
Legal Description
Project Description pool A 1.5101a
.. n. • _ . r O I. i .4 , .
:ing with Section
in full force and
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License law for the following
reason: /Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, 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
the provisions 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 five 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.)
❑ I, 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 contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. 8 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
Copy is filed with the city. ❑ 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 .($100) valuation
or less.)
I certify that inthe performance of thg work for which lhis�.permit is issued, I shall not
employ any person in any manner so,as'to become subjec�to the Workers' Compensation
,
Laws of, California:.
Date`s' R'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.
,
0 A, 1� 9 2.,
Minimum Setback Distances:
Front Setback from Center Line_
.Rear Setback from Rear -Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
rSq. Ft.
Size
k,
No. Vis.
Stories
No; Dw.
Urifts
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Lender's Address
FINAL DATE
N
I�S,P-�CT
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information Is correct.
Issued by:
Date Permit
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-
-
Estimated Valuation
00000
Validated by:
PERMIT
AMOUNT
Plan Chk. Dep.
`i ♦e�e�
Plan Chk. Bal.
Const.
W]
Mech.
i b o ul)
Electrical
.?Q RUU
Plumbing
1.41 U€j
S.M.I.
l o 44
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
i*,n ,A. 7'i !>rht.', r i5?3' „_ i 4
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line_
.Rear Setback from Rear -Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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.)
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE
N
I�S,P-�CT
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information Is correct.
Issued by:
Date Permit
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.
Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
WHITE FINANCE, PINK -.APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY c FILE-
. .... ... _. ..,o .... ...x..1 .-. ... .. _.. ._._... _, C�.,. ,,.• I .. _.. .....•...: :. .., _.... �.. _. s _,.:. _i -i. .., _.ea �. .. � ,�L.•,t'., .. ,. :. ,._r. ..
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
IST FL SO FT (p $
UNITS
UNDERGROUND
A.C. UNIT
COLL. AREA
YARD SPKLR SYSTEM
2ND FL SO FT. a
BONDING
HEATING (ROUGH)
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR SO FTa
DUCT WORK
ROCK STORAGE
FOUND. REINF. '•
POWER OUTLET
ROOF DRAINS
GAR SO. FT. ro
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ FT. ra
GROUT
WATER HEATER
SERVICE
FINAL INSP.
DRINKING FOUNTAIN
WALL SO. FT. (d
WATER SYSTEM
GRADING
cu. yd.
$ ' plus
I
I URINAL
SO. FT. rd
FINAL INSP.
FRAMING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOYDISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
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. g c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1 1 c
SEWAGE DISPOSAL
SO.FT.GAR gr Ii.c
HOUSE SEWER
FINAL INSPECTION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE bL.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
I
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 SIGNATURESHNITIALS
GARDEN WALL FINAL