001730 (RPL)P.O. BOX 1504 No. 001 730
Building 78-105 a 55-783 HM LA QUINTAC
Address CALIFORNIA 92253
Owner
s'°Wim W. BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address 75-905 Cpmtr t Club Dr. A.P. Number
City Zip Tel.
.� � 9226 568--2828 Legal Description i5
Contractor Project Description P.G.Q. MT M&IS '
67712Fw=PA. 7x8.Sna
City Zip Tela
Mt a Citi 922 32-3-7303
State Lic.
City
& Classif.1
�
Lic. #
Sq. Ft.
Size
No. No. Dw.
Stories Units
- Arch.; Engr., • • '
Designer
New 2 Add ❑
Alter ❑ Repair ❑. Demolition ❑
Address
Tel.
City
Zip
State
,t
Lic: #
- LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect. -
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following�.�fsn�
Estimated Valuation
7,500.00
. reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
'
-
•. PERMIT.
-•- - AMOUNT
_
permitto construct, alter, improve, demolish, 'or repair any structure, prior to its issuance also
requires the applicant for-such*permit to rile 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 live. hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages.as their sole compensation, will
. Plan Chk. Dep..
_
-
Plan Chk. Bal..
Const.
".52
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
Mech.'
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
Electrical'
�Ow�ib
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.) -
Plumbing
14.00
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
- slruct 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
S.M.I. -
`
such projects with a contractor(s) licensed pursuant to the Contractor's -License Law.) -
❑ 1 am exempt under Sec. B. & P.C. foe this reason
Grading
Driveway Enc.
Date Owner
Infrastructure
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.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
-(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.) - -
I certify that in the performance of thg work for which this permit is issued, I shall not
- employ 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,
-ZONE:
BY:
subject to *the Workers' Compensation provisions of'the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:
Front..Setback from .Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
herebyaffirm that there is aconstruction 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
FINAL DATE
Issued by:
Validated by:
Validation:
A2710
-
INSPECTOR
Date 9-27-05 Permit
9 27 16055 Ck
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. f
}} ip
,Signature P r? Date 4 •moi r{
of applicant A + ± ` Lt -
Mailing Address
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
1ST FL. SQ. FT. ®
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. @
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
NO. ELECTRICAL EGFI&
UNITS
MOBILEHOME SVC.
POWER OUTLET
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
A.C. UNIT
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. .@ c
BATH TUB
SERVICE
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LUMBER GR.
GAS PIPING
PERMIT FEE
PERMIT FEE
I PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUM BINGO Oi J
/ 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 APPJEQUIP.
REINF. STEEL 119
i
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
IN5PtG1 UX'5 WUNA I UMLWINI I IAL5,
GARDEN WALL FINAL