001881 (SATT)44 �AV
ab4
P.O. BOX 1504 No. 001881
Building O
54-148 LA QUINTAC
Address CALIFORNIA 92253
Owner
swuim OMPMY BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address 75-005 Likin MAW A.P. Number
City Zip Tel.
922SO 568-292 Legal Description
ContractorPCh W P'AN 10
Project Description
Address
Sam
City Zip Tel.
State Lic. City 1 2
& Classif. Lic. # 328 Sq. Ft. No. No. Dw.
Size 424 Stories 1 Units
Arch., Engr.,
Designer New N. Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
2915 -Bill Ave. (714) 540-5117
CityZip State
r g26Bfj Lic. #
LICENSED CONTRACTOR'S DECLARATION . -
I hereby affirm that 1 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 +•'
effecL�
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 INSU RANCE
(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 the 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
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 theperformance 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 1he above-
mentioned property for inspection purposes.
y
Signature of applicant-�l %= Dale fi
Mailing Address 7 f
City, State, Zip f
HARD COPY
n ras ruc ure
TOTAL
REMARKS
M
s
'__A.1
AMOUNT
324.94
3-11.14
'34.00"' .
59.99
97.50
5.99
ZONE:
BY:
SIGNATURE i i-' ,/ ,_" - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
t
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 rile a signed statement that he is. licensed pursuant to
Rear Setback from Rear Prop. Line
PERMIT
Me provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
'
Plan Chk. De�"
p•\'
' Division 3 of the Business and Professions Code, or'that.he is exempt therefrom, and the basis'
for the_ alle ed exemption. An violation of Section 7031.5 b 'an applicant ' for a
9 P� Y Y Y aPP Permit
subjects the applicant'to a "civil penalty of not more than rive hundred dollars ($500). "'
0 1, as owner of the property, or my employees with wages as their sole compensation, will -
Plan Chk. Bal.
Const.
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
E18CtrICel
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.
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
•strucl 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.)
C 1 am exempt under Sec.. B. & P.C. for this reason
Grading
Driveway Enc.
1 f t t
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 INSU RANCE
(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 the 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
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 theperformance 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 1he above-
mentioned property for inspection purposes.
y
Signature of applicant-�l %= Dale fi
Mailing Address 7 f
City, State, Zip f
HARD COPY
n ras ruc ure
TOTAL
REMARKS
M
s
'__A.1
AMOUNT
324.94
3-11.14
'34.00"' .
59.99
97.50
5.99
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
Issued by:
Date Permit
VaMdated by:
Validation:_
A3241
2ii9,42 R
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FE ',a
NO. PLUMBING FEES
1ST FL. SO. FT. ®
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
EWER ORS It•
r7ROUGH WIRING
POWER OUTLET
ROOF DRAINS ,
GAR. SQ. FT. ®
METER LOOP _
DRAINAGE PIPING
CAR P. SO. FT. ®
REINF. STEEL
WALL SQ. FT. ®
AS (FINAL) /
v
DRINKING FOUNTAIN
URINAL
SQ FT ®
WATER HEATER
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
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(AUTO)(DISH)
APPLIANCE DRYER
ii FRAMING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
^) fl ROOFING
LAUNDRY TRAY
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.
SQ. FT. ®e
BATH TUB
SQ. FT. ® c,
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 % c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
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
ND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
RMS �a f If
EWER ORS It•
r7ROUGH WIRING
DUCT WORK
ROCK STORAGE
-1 N FOUND. REINF.GAS(ROUGH)
METER LOOP _
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
AS (FINAL) /
v
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
\
=$
LUMBER GR.
AL INSP. S
ii FRAMING
FINAL INSP.
^) fl ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S
SIGNATURES/INITIALS.
GARDEN WALL FINAL