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08-1597 (ELEC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 08-00001597 Property Address: 78650 ALDEN CIR APN: 604-225-014-97 -23268 - Application description: ELECTRICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: /X400 Applicant:.' T -4y 4 e(Pa" Architect or Engineer: LMM ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING &.SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: B C10 License No.: 816900 Date:1n,_*e, k Contractor: _A4w9( J<ol % OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she 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 five 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, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the 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 of proving that he or she did not build or improve for the purpose of sale.). (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ( 1 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.1. Lender's Name: Lender's Address: IIIIIII VIII III VIII IIII 78 LQPERMIT IE VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/19/08 Owner: POWERS GARY & STEPH, SUE 78650 ALDEN CIRCLE;' LA QUINTA, CA 9225 (760)772-2395 �v O C 9? Contractor: � O�c, 0 LANDRY, BRAD req 874 BORDER #D-16 ���OFpTTq JOSHUA TREE, CA 92252 (760)218-0357 Lic. No.: 816900 ----------------------------------------------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance,.as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier EXEMPT Policy Number EXEMPT 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, and agree that, if I should become -subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. - Date: `ps' - Applicant: �r 10.1 A— ill v WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND'SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1 . Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. 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 county to enter upon the above-mentioned property for inspection purposes. Date-Ino10Signature (Applicant ar Age *1-� ..a Application Number . . . . . 08-00001597 Permit . . . ELEC-SERVICE CHANGE Additional desc . Permit Fee . . . . 33.50 Plan Check Fee .00 Issue Date Valuation . . . . 0 Expiration Date 3/18/09 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 18.5000 EA ELEC SVC <=600V/<=200A 18.50 ---------------------7------------------------------------------------------ Special Notes and Comments ELECTRICAL SERVICE PANEL CHANGE OUT 125 AMP TO 200 AMP Fee summary ----------------- Charged -------------------- Paid Credited ---------- Due Permit Fee Total- 33.50 -.00 ---------- .00 33.50 Plan Check Total ..00 .00 .00 ..00 Grand Total 33.50 .00 .00 33.50 G LQPERMIT i Bin # City of La Quinta Building & Safety Division Permit # P.O. Box 1504, 78-495 Calle Tampico h La Quinta, CA 92253: (760) 777-7012 Building Permit Application and Tracking Sheet Project Address: 7qo ToAZ 4& e , ( Owner's Name: LcAS G A. P. Number: Address: -0 . Legal Description: City, ST, Zip: Contractor: 19 f I -.� 9 ...–r Address: I(,-, Telephone: x Project Description: City, ST, Zip: c ? 1 IQ iCr1 nC rC Telephone: ( Z S zoo State Lic. #(o GQ, City Lic. #: Arch., Engr., Designer: Called Contact Person Address: Plan Check Balance City, ST, Zip: Energy Cales. Telephone: State Lic. #: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: /! Sq. Ft.: —T# stories: #Units: Telephone # of Contact Person: 2 / 'V^ O Y-7 Estimated Value of Project: APPLICANT- nO NOT wR1TF RGi nw YWC i Mr N Submittal Plan Sets Req'd Rce'd TRACKING Plan Check submitted PERMIT FEES Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Energy Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2'4 Review, ready for corrections/Issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''' Review, ready for correctionsfissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees 111111111111111111111111179 IE Building 78-00 Alden Circle Address •t ' Owner Acacia ConStruCtion t�'rGu Y 4P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Address 1421 W. Bastanchu'y City Zip Tel. Fullerton 92533 714-992-OWO Contractor Address State Lic. City & Classif.? Lic. # Arch., Engr.', .Designer AddressTel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that'm 1=alicensed udder provisions of Chapter 9 (commencing with Section -7000) of Division' 3yofthe Bu as ndProffessionseCC'o e, and my licenseisin full force and effect.-11.x3%.r4t ..P"•fn L` `..t„rr� +'i OUT!!? SIGNATURE"^"" .�i" ` �"' ./ DATE OWNER -BUILDER DECLARATION ` I hery affirm that 1 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, 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 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 or not more than five 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. If, however, the building 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.) O 1, 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 I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, ora certified copy thereof. (Sec: 3800, Labor Code.) Policy No. Company NCopy is filed with the city. O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM 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., It, 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 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. 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 sof this city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip No. 07830 BUILDING: TYPE CONST. OCC. GRP. A.P. Number Acacia Roues Legal Description Tract 23268 PI an 8-2 Rev. Project Description Lot 97 Sq. Ft. 1721 No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $93,558 PERMIT, Plan Chk. 'Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. i AMOUNT Grading Driveway Enc. Infrastructure TOTAL 3,509.16 REMARKS rr..r+.-e•+ v e—sr— 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 5/4/90 Permit Validated by: Validation: CGNSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE 2ND FL. SO. FT. BONDING YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT, ® POWER OUTLET [I ROOF DRAINS CAR P. I SQ. FT. GAS (ROUGH) DRAINAGE PIPING WALL SQ. Ff. OTHER APPJEOUIP. DRINKING FOUNTAIN, SQ FT ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FRAMING a ( �� �/ [� GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM EMARKS: REMARKS: 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. ®c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 34c HOUSE SEWER MESH 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 1 1, _ 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'SI•PRCTRRf 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. s- O FRAMING a ( �� �/ [� FINAL INSP. Lj{ c EMARKS: REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL {�ltl f LATHII G =,791 MESH INSULATION/SOUND/ ; L FINISH GRADING > P FINAL INSPECTION 1q [D CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL • I�I��i� ���i� �I� I�lil Ili 80 4�IE P.O. BOX 1504 N 0 . v Building �� 7&105 CALLE ESTADO Address 78— �P•1C12n Circle LA QUINTA, CALIFORNIA 92253 Owner Mailing Mack Stutz BUILDING: TYPE CONST. OCC: GRP. Address Same A.P. Number City Zip Tel. La Quinta 92253 345--3033 Legal Description Contractor Project Description Patio Cover owner/Builder Address City Zip' State Lic. City & Classif. Lic. # Sq. Ft. 14 4 No. No. Dw. Size Stories Units Arch.; Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑ Address Tel. City Zip State 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 effect. _SIGNATURE DATE OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License law for the following 1886.40 reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also requlies 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 is exempt therefrom, and the basis the Any Section 7031.5 'by •any for Plan Chk. Dep. ` ;g .for alleged exemption. violation of applicant a permit subjects the'spplicant to a civil penafty of not more than five hundred dollars .($500). - PKos owner of the property, or my employees with wages as their sole compensation, will d"o the Plan Chk. Bal. work, and the structure is not Intended.or offered for sale. (Sec. 7044, Buisness and Const. - `� 45.00 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. r ` 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 -budder will have the burden Electrical or 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 ProfessionsCode: The Contractor's -License Law does to builds improves thereon, for ryt/�! 20 not apply an owner of property who or and who contracts such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) S.M.I. . Grading . ❑ I am exempt under Sec. B. & P.C. for this reason Driveway Enc. Date Owner �,f ,mP f'r 'fes Infrastructure - J - WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of ' WorkePs Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company {i (v G/ f�}' W�?` i t# 1 t At- � to If ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL ti+ i -r9 • 74 . 4!) CERTIFICATE OF EXEMPTION FROM 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 ma ner so as tobecome subject to the Workers' Compensation Laws of California - J Date Owner `^+� * L 1 NOTICE TO APPLICANT IfF 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 provisionsror this permit shall be deemed revoked. r CONSTRUCTION LENDING AGENCY I=firm 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. ' 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. Signature of applicant Date Mailing Address City, State, Zip 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 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS COLL. AREA 2ND FL. SO. FT. YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. I SO. FT. DUCT WORK DRAINAGE PIPING WALL SO. FT. DRINKING FOUNTAIN SO. FT. ® HEATING (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ 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 GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GRADING cu. yd. $ plus x$ 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 1AMPERES 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 ® 11/4 c SEWAGE DISPOSAL FIREPLACE SQ.FT.GAR ® 3/ac HOUSE SEWER SPARK ARRESTOR 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 GRADE1,197 ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REIN 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 f l C FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION l� G CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL :d r I IIIIIII IIIII III IIIII IIII 01 • No. Stories No. Dw. Units { IE Building Address 7p_1;R0 ,1t►�d �►n IP$r+ Owner Jack. Stutz Mailing) , Address _ City AMOUNT • •'. Plan Chk. Dep. Zip T,A mi 4.rit m 47:)904 Contractor 253,00 f_'�Ii £rarxtire P�c;1.� Address Electrical 45 00 Plumbing City — ~Zip _ Tel State Lic. City & Classif. Lic. # Arch., Engr., Designer Address Tel. P.O. BOX 1504 N 0 . 088 Q 4 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 BUILDING: TYPE CONST. OCC. GRP.- A.P. Number . Legal Description Project Description 1.74 x 'AW Pne)'t_ w/72 sna City P Zi State Lic. # fJ t LICENSEbfCONTR��OR'S DECLARATION I hereby affirm that I,am,llcensed umler roJi�ions o4 Chapter 9 (comme�'lcin with Section 7000) of Division��33ppf��t�heJBusiness and P of /i s Code, and my license is !If full force and effect. Al7? l t _ �!% J Ai t OWNER -BUILDER DECLARATION I hereby affirm 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, 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 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 five hundred dollars ($500). O 1, 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, t. 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 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.) O 1 am exempt under Sec. B. & P.C. for this reason . 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. O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (8100) 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 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. 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. Signature of applicant Date Mailing Address City, State, Zip 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 Validated by: Validation:_ Sq. Ft. Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation 23 800.00 PERMIT AMOUNT • •'. Plan Chk. Dep. Plan Chk. Bal. 99.45 Const. 253,00 Mech. 24.00 Electrical 45 00 Plumbing 27.00 S.M.I. .99 t Grading Driveway Enc. Infrastructure r C�` TOTAL 349.43 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 Permit Validated by: Validation:_ CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. Fr. ® $ UNITS SLAB GRADE 2ND FL. SO. FT. YARD SPKLR SYSTEM STORAGE TANK MOBILEHOME SVC. BAR SINK POR. SO. FT. ® DUCT WORK ROCK STORAGE GAR. SO. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APPJEOUIP. DRAINAGE PIPING CAR P. I SO. FT. WALL SO. FT. GROUT DRINKING FOUNTAIN. SO FT ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM FINAL INSP. G FINAL INSP. ) WATER PIPING NOTE: Not to be used as property tax valuation _$ FLOOR DRAIN MECHANICAL FEES ROOFING "'ATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER VENTILATION GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM I IKITCHEN 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. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1114 c SEWAGE DISPOSAL SO.FT.GAR ® 3/4c HOUSE SEWER FINISH GRADING 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 q ---i/ PLUMBING ELECTRICAL HEATING & AIR GOND. SOLAR SETBACK GROUND PLUMBING d! v UNDERGROUND) lair! 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) ( ) (115A& METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. G FINAL INSP. ) o L d GRADING cu. yd. $ —Plus—x$— _$ LUMBER GR. FRAMING ROOFING %�C /ho I1 ��`�yv�►1�P -- l J (`Z V g —prL ( REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION 02 CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL