003113 (SFD)44
P.O. BOX 1504 No. 00311
Building LA QUINOTACCALIFORNIA92253
Address ...3"s`990 Obregon .
Owner
John Lopez
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address 53-290 0bT_ ` *n A.P. Number - 774 -074,-* 025
CityZip Tel.
La Quin as • Z. _ 92253 Legal Description
Contractor. Project Description
Address
City Zip' Tela"
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Size - Stories Units
Arch:,'Engr.,
Designer New ❑. Add g Alter ❑' . Repair ❑ 'Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION.
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- ' w 'Z'r1 >"^i C':I +•` i •7
• .. .. �f3,1.� .i :F+ r(;:3 ii:.'hsNr':' ir'):... 4 %i •rlr l .:,.f<: K: �.:.
'OWNER -BUILDER DECLARATION 'r ores. r
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 file a signed statement that he 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,'or that -he Js exempt therefrom, and the basis Plan Cfik: De -
for the alleged exemption. Any violation of Section 7031: y"
5 bany applicant for a permit' p
"'subjects the applicant to a civil penalty of not more than five hundred dollars* ($500).
01 1
I, as owner of the property, or my employees with wages as their sole compensation, will. PI2n.Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and COr1St.. 12;j 40
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
or improvement is sold within one year of completion, the owner -builder will have the burden . Electrical -
of proving that he did not build or improve for the purpose of sale.) -
❑ I, as owner of the property, am exclusively contracting with licensedcontractorsto 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-L''
such projects with•a contractor(s) licensed pursuant to the Contractor's License Law:)
Grading
❑ 1 am.exempt under.Sec. B. & P.C. for. this. reason
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
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 - 2QeSO
• CERTIFICATE OF EXEMPTION FROM • REMARKS
WORKERS' COMPENSATION INSURANCE
(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 Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. - -
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 INSPECTOR
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. Issued by: Date C /9 A 7 Permit
I agree to comply'with all city and county, ordinances and state laws relating to building
construction, and hereby authorize representatives sof this city to enter the above -
mentioned property for inspection purposes. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. I SQ. FT.
WALL SQ. FT.
SQ. 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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SEWER OR SEPTIC TANK
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,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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
BOND BEAM
SQ.FT.GAR ® 3/ac
HOUSE SEWER
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.
FRAMING6
!!!///
FINAL INSP.
ROOFING
t
- --
DEC 1 "
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING /
3
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
:d