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002428 (ELEC)tyl 44 P.O. BOX 1504 N o . Building55-030 Oak LA QUINTAC Address CALIFORNIA 92253 Owner Awwim 002428 BUILDING: "TYPE CONST. a OCC: GRP. Ivran N I .. Address 75-€ o5 cbmitm cub rx. A.P. Number CityZip Tel. •' P�AIM 922-6050-2828- Legal Description ContractorProject Description Natl. t=tQ. and bald Address City Zip Tela State Lic. City & Classif. 299130 Lic. # 328 Sq. Ft. No. No. Dw. Arch:, Engr., - • • - • ' - ' Size Stories Units Designer New ©: Add ❑ Alter ❑• Repair ❑ - Demolition ❑ Address Tel. City Zip State 16 MtEmsi po'leS " II %kt 10A and Rear Setback from Rear Prop. Line Lic. # Side Street Setback from Center Line LICENSED CONTRACTOR'S DECLARATION FINAL DATE 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 " - Date 6-24--86—Permit -. effect. .. SIGNATURE DATE A 5 8 5 8 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License law for the following. Estimated Valuation - 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 thathe is licensed' pursuant to PERMIT - AMOUNT the provisions of the Contractor's License Law, Chapter 9.(commencing with Section 7000) of Division 3 of the` Business and Professions Code, oi`that. he is' exempt therefrom, and the basis Plan for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Chk. Dep. - .• ' ' .. subjects the applicant to a civil penalty of not more'than five hundred dollars ($500). ' Plan Chk. Bal. ❑ 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 Const. 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, Mech.' provided that such. improvements are not Intended or offered for sale. If, however, the building .Yt�Yt[g or improvement is sold within one year of completion, the owner -builder will have the burden Electrical - -•YV . 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- Plumbing 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 ' S.M.I. such projects with a contractors) licensed pursuant to the Contractor's License Law.) Grading .7.1 am exempt under Sec. B. & P.C.-for this reason. Driveway Enc. 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. , ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed i1 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 or 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. .l certify that I have read this application and state that the above information is correct. I agree to comply with all ciy and county orbiriances 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 HARD COPY Infrastructure TOTAL++• REMARKS .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 6-24--86—Permit Validated by: Validation: A 5 8 5 8 6 24 50,00 U CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. POR. SO. FT. ® GAR. SO. FT. ® CAR P. SO. FT. WALL SO. FT. ® SO. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE 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 ® 1 'A'c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER REMARKS: 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 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 APPJEOUIP. 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 INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL