06533 (SFD)Building
Address
Owner
Mailing
Address
City
4
P.O. BOX 1504 No. 06533 35'
54-650 Riviera LA QUINTACCALIFORNIA 92253
Sunrise
Contractor
Address
62--600 Cook St.. 0200
563--2828
City
Zip
Tela
State Lic.
& Classif. 288130
City
Lic. # 328
Arch., Engr.,
Designer
Address
I Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
71XX1) 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 affirin 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, after, miprove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rite a signed statement that he is licensed pursuant to
the provisions of he 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 afleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civilpenalty of not more than rive hundred dollars ($500).
❑ 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. g, however, the building
or improvement is sold within one year of completion, the owner -budder wig have the burden
of proving that he did not build or improve for the purpose of sale.)
O 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. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
Work1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
er'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'COMPENSATIONINSURANCE
(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: ft, 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 the per'ormance 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 tof this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE CONST. .00C: GRP._
A.P. Number PGA.Vast, Tract 24317-1
Legal Description
Project Description
Phase/2U Plan 02A
Sq.; Ft. Z= 3355 No. No. Dw.
Size Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$243,165
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
81.50
Electrical
s.;.; li,
Plumbing
180.5D
S.M.I.
Most
Grading
Driveway Enc.
Infrastructure
MA . 2 7AMS4,
T
t
TOTAL
REMARKS
lir,+ i 1? i[t 0A #,31
1u, a 1xt.
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 INSJEUC.Tff
Issued by: Date ll II Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL SQ. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
DRAINAGE PIPING
CAR P. I SO. FT. ®
GAS (ROUGH)— �_ qC)
METER LOOP
WALL SQ. FT.
HEATING (FINAL)
DRINKING FOUNTAIN.
SQ FT ®
GAS (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER HEATER
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
cu. yd.
plus x$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
'1
FINAL INSP.LI /
LAUNDRY TRAY
AIR HANDLING UNIT CFM
ROOFING
W
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
FIREPLACE
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
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
LUMBIN&Zn57,1
UNDERGROUND
A.C. UNIT
COLL. AREA
GRADE il
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FO S
EWER OR SE C qA::)
ROUGH WIRING
DUCT WORK
ROCK STORAGE
UN !REINFy
GAS (ROUGH)— �_ qC)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL E
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
-$
LUMBER GR.
'1
FINAL INSP.LI /
RAMING
FINAL INSP.
ROOFING
W
1. ®l� *Q f.�
9 ��rj�
/LOGO / (—
REMARKS -
REMARKS
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
�iLATHING
MESH
INSULATION/SOUND
t
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
'
GARDEN WALL FINAL
1