SFD (0107-161)51820 Avenida Madero
0107-161
LICENSED CONTRACTOR DECLARATION
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 # Lic. Clasp Exp. Date
,5 '774 . B . 0/1
Date Signature of Contractor --
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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 & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
() I am exempt under Section , B&P.C. for this reason
Date Signature of Owner
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
$Mfion 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carver Policy No.
Wail C'tJ.M–P
W Dal 1230
(This section need not be completed if the permit valuation is for $100.00 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, 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 pr6vislons.':%'-1
Date: 1^ Applicant
Warningrfaittlrg"to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $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.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
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 applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
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 State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) -- % , ' Date, - r ^
BUILDING PERMIT PERMIT#
DATE } VALUATION LOT 1- , , TRACT
%//
✓ 3 B 7 r p
JOB SITE
ADDRESS
142; ..VEMA MA : 0
r 254-004
:EN
OWNER
CONTRACTOR /DESIGNER (NEER
1•,•
3 . t DJAK'sR ENT` '. '.3;?IUMIS
1%FE i9,i.: T, WKW MorER."tsRIS.08,r
197.1111.1 MOWS 0.1.01' 13, DIRIV4Z
IM '. M1110a11MI 7)7M11
UMb?1. kDWO CO. 92406
SAW B— R14ARDINO CA 97,408
(SK19)884-7241 CEIR 4706
USE PERMIT
i
iO,Fynr ry y yam= y}
Fd1Itl'r9J.a 1111 : L
Si f , 'DOE, 'NOT INCLUDE k1VJCX'`w/X= I?004 OR 1)iF.Vi .'y5'AX
P-FDU£ TIO14 FOR :v➢;rIX 7. f4"Li 'NE:li.IV TS OF W:-s4Es E PIAN TYPE
#'1'i.ACT C01su'1'RUCTX014 11110109 11 Y
PORC11;11 .A'1't0 52,60 Sy
OAR AMUCAMRT 451,00 OF
B"M C.08 .1..r.4! i.r091G,b RATJ4...8..i O I
202,423AO
U69.
CONSTRUCTION JWX. 301-000-418-000 31S3i1.W
PLAN CHECK FIRM 1101-000-439-318 $136.18
PZ* ]APOSIT 101-0m,439a318 -5250.00
Z01"9ML%121511-00"21-Wo $66.59
RIXOM8c"AL WE 191.000-420.000 111141
PLIJIMR2140 iPf1l~' ) 01 tx)i 19.600 $136.00
a"1`Itowa m oT'IciX r,aE - RKsi1'1 I(11-(,tt?5?- A.00,,
€'+lala,F.lAitkl::101•6.00-421.•00iMAW
-
D ti7lVERWRCry G $11907.60
4>ii.EC131f T'L&14 D 10 d(. • -M4 -315 $100,00
AUG 17 2001
k1SF r? -"I '3" a1 d,C 11x" r t .. NO'
CffY OF LA
FIN NCE DE :M 1'; `" PAi FE&I
4215 ).00
11UTM, PKWIMFP 9 R; ME 940'W
$243"133
RECEIPT
DATEj
BY
DAT F ALE
INSPECTOR
{,Jr1 L
INSPECTION RECORD .Ap
OPERATION
DATE
INSPECTOR
OPERATION
DATE
-INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Slab Grade 40T
^ e
_Q 3 !!r
41
V (
Underground Ducts
Ducts
Return Air
Steel
Combustion Air
Roof Deck
0. K. to Wrap
Framing
Insulation
t j_ p (- Q (
.-
Z/!/O(
Z y-2(-L
'j -r
✓,1
Exhaust Fans
F.A.U.
Compressor
Vents
Fireplace P.L.
///
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final /,/OL
Final
POOLS - SPAS
BLOCKWALL
/// (((
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
_/
6/ 0
_
Heater Final
Plumbing Final
Plumbing Top Out
CCC
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral_
Sewer Connection
Gas Piping
_
t I (p
,S3
`
Pool Cover
Encapsulation
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) SEG Q- r0 v ,'
0(0716/
S-)- M /
Building
Address
OwnerA / n h,t
I . r,
Mailing ,
Address f • 4r -S G '. 4 L'_ ` f
City _ lZip ITel.
Contractor
4
P.O. BOX 1504 J
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
APPLICATION ONLY
BUILDING: TYPE'CONST OCC. GRP.
A.P. Number 4:
Legal Description ` (
Project Description
city
A)
Zip
State Lic.
& Classif.
City
Lic. #
Sq. Ft. A / .
6
No. No. Dw.
,-2,5`'7/ 7
Size oG/
Stories Units
Arch., Engr.,
Designer
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
Tel
11 ' < ( '" %`` 1
CityZip
State
Lic. #
^' t
LICENSED CONTRACTOR'S DECLARATION
_
I 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.
r
SIGNATURE DATE
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
AMOUNT
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).
IJ 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
Plan Chk. Dep.
)
Plan Chk. Bal.
i
Const.
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
Electrical
orimprovement 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
II I, as owner of the property, am exclusively contracting with licensed contractors to con-
strucI 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.1.
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
1-1 I am exempt under Sec. B. 8 P.C. for this reason
Grading
Driveway Enc.
Date Owner
infrastructure
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
n Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(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, alter 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.
ZONE: BY:
Minimum Setback Distances:
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
L DATE 7)
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 1 have read this application and state that the above information is correct.
I
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.
t
Iida ed by:
Signature of applicant Date
MAY
- 4 2001
Mailing Address
lido ion:
CITY OF
I 'P 1('•'^F
APPLICANT— --PINK
LA QUINTA
DEPT
l3L4LMNG DIV SH IN
City, State, Zip
WHITE = FINANCE YELLOW =
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
Date 8/17/01
No. 22388
CERTIFICATE OF COMPLIANCE
APN# 773-154-004
Jurisdiction La Quinta
Owner NameNeal T. Baker Enterprises
No, 51-820 Street Avenida Madero
city La Quinta zip 92253
Permit # 0107-161
Log #
Study Area
Tract # BL31 U2 Lot # 21 Square Footage 1710
Type of Development Single Family Residence
Comments
No. of Units 1
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It
has been determined the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 ,` in the amount of
2.05 X 1,710 or $ 3,505.50 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed projectfmay now be issued
Fees Paid By ccB of A - Rick Webb Telephone 909-424-8912
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received $3,505.50
Check No. 2009865336
Signature
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
:ollect them on the Disfict('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
IN
RC DISTRICT - PLANNING REVIEW FORM
This form is to be used by CDD staff for review of single family dwellings in the RC (Cove
Residential) District per Section 9.50.090 of the Zoning Code. Its purpose is to determine:
1) that the proposed house design does not duplicate the same architectural style of any
house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for
Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please
transmitted this information to the Building and Safety Department as part of your correction
list. Please attach additional explanations as necessary.
APPLICANT Neal T. Baker, Ent.
SITE ADDRESS 51-820 Avenida Madero
APN 7: 3 ooy CASE NO.:
LEGAL: LOT 21
BLOCK 3/
2001-465
UNIT Z S.C.@V.L.Q.
CHECK AND APPROVED BY: Wally Nesbit DATE:
Inform the assigned Building plan checker upon your assignment to this case. The CDD
Executive Secretary maintains a log book to track applications and assign case numbers.
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Verify legal and APN information
•26, 7- I'M
iv,oOc.cc,a.✓T' £
Consistent with MDG on file (as
applicable
MDG filing required (5 filings since
9/3/98)
Architectural variety within 200 feet of
the surrounding area:
RECVD FOR PROCESSING :5-1-)'101
(DATE) Colors
ASSIGNED TO
(INITIALS) Materials
pvw.s !1-g°-6
Architectural design features
?
Ge o✓ts ~`' o v ,o4o
ments:Q
Planning Commission
City Council
Community Dev. Dept. Z °
nitials CSa ,. ._, . ...,._..._....
Paso No.. 2.701 5/6 Z- ....._....
"ith Conditions
WHEN, RECORDED MAIL TO:
! EAL• T. BAKER ENTERPRISES, INC
1875BusinessCenter Dr
4=) :San ;Bernardino, Calif 92408
ESCROW NUMBER: 1765—K
ORDER NUMBER:
MAIL TAX STATEMENTS TO:
NEAL T. BAKER ENTERPRISES, INC
1875 Business Center Dr
San Bernardino,'Calif 92408
E W k o0
om.
C_.)
; o Q ¢c3
oLLZ0
W si ¢` JQ w
w N
W ` 3
CC LL
SPADE ABOVE IIII:: LATE FOR flf_(;OIiUFR'S USE r +
DOCUMI=NTAnY rnANSFFn TAY, 5,.. ...?J,
X ... (;nnynilrrl rn, tl,r , ,nr.irlrr ti ,n ra -11w.
OI prnl,rnly c•mvr,;r•a; on
.. (;nngnrl •I r,n Ih r rur:itlrrnlinn rr :•. Irin I sc linnc i)r r m•nhnl•rnnrr•c
r^n,:,in in(1 nt limn „( c:,lr.
up.yi nig: ul li,. a:n nal ,•i Aq^nl hl •i% mih dr,il I . flim rlgn,.p _ _._ _
GRANT DEED
FOR A. VALUABLE CONSIDERATION, leceipt of which is hereby acknowledged.
N1 JOHN REGINALD MURPHY
l
Nhereby GRANT(S) to
NEAL T. BAKER ENTERPRISES, INC., A California Corporation
M : .
v _ the real property In the City of
County or I,a Quinta
Riverside
AS PER LEGAL DESCRIPTION ATTACHED HERETO AND MADE A PART HEREOF:
F , z Q'
1! a- U;' in
, Stale of California, described as
Dated- I " Ll.t ( aCZ. / 1/%/ r'rc z
July- 42, 1988 —-_.._._ _......._._..
lJOHN REGIJAirD MURPHY
STATE OF CALIFORNA /
COUNTY OF SAN/ EG J -
on
before me, the undeisigned, a Notary Public In and for said State, per,
sonally appeared M1
1 i
I ----'----- -- - ...------- - - ------ OFFICIAL SEAL
(( perslonally known to me (or proved to me on the basis of satisfactory' `-" B'' =SRA McCULLEY
evidence to be the ersonylj whose Tarn(, islare subscribed In Thrrl,cf rimer hi-IrORNIA
p Vh
t v, f it•4CIPAl rlrrlCr IN
within Instrument and arknowln(lyrd in mr flint llrlahAlthPy exr culrrl ' r yZ S.111 UII:GO CRI!'!Ty
the same. Aly Commission rzp. Sept. 10, 1990
WITNESS my hand and official seII
71
Signature / _ C (✓ / C r (Thin ., ,.;, b„
FORM NO. GD 4001183
( ) ( MAIL TAX STATEMENTS AS DIRECTED ABOVF
LEGAL DESCRIPTION
PARCEL I:
Lots 4 and 5 of Block 29 of Santa Carmelita at Vale La Quinta, Unit 2 as shown by
Map on file In Book 18, Pages 55 and 56 of Maps, Records of Riverside County
PARCEL II:
Lot 10 of Block 30 of Santa Carmelita at Vale La Quinta, Unit 2 as shown by map
on file in Book 18, Pages 55 and 56 of Maps, Records of Riverside County
PARCEL III:
C? Lots 31 15, 17, 19, 20 and 21 of Block 31 of Santa Carmelita at Vale La Quinta,
C Unit 2.as. shown by Map on file in Book 18, Pages 55 and 56 of Maps, Records of
Riverside County
.I Y
PARCEL IV:
Lots 20 and 24 of Block 32 of Santa Carmelita at Vale La Quinta, Unit 2 as shown by
Map on•file in Book 18, Pages 55 and 56 of Maps, Records of Riverside County
PARCEL V:
Lots 7, 8, 9 and 10 of Block 33 of Santa Carmelita at Vale La Quinta, Unit 2 as shown
by Map'on file in Book 18, Pages 55 and 56 of Maps, Records of Riverside County
Lots 3, 4, 20, 21 and 22 of Block 34 of Santa Carmelita at Vale La Quinta, Unit 2
as shown by Map on file in Book 18, Pages 55 and 56 of Maps, Records of Riverside
County
NEC[= IVSD/AUG U 4 Intl
LA QUINTA PROPERTY LEGAL DESCRIPTION
PARCEL III
LOTS 3, 15, 17,19, 20 AND 21 OF BLOCK 31 OF SANTA CARMELITA AT. VALE LA QUINTA,
UNIT 2 AS SHOWN BY MAP ON FILE IN BOOK 18, PAGES 55 AND 56 OF MAPS, RECORDS OF
RIVERSIDE COUNTY
LOT 3
51825 AVENIDA JUAREZ
PARCEL #773154015-9
LOT 19
51860 AVENIDA MADERO
PARCEL #773154006-1
LOT 20
51840 AVENIDA MADERO
PARCEL #773154005-0
LOT 21
51820 AVENIDA MADERO
PARCEL #773154004-9
June 12, 2001
City of LaQuinta
Dept. of Building & Safety
Re: Baker House
The undersigned Engineer of Record (EOR) has reviewed the truss design criteria for the
above project for conformance with the project requirements. The EOR was not in
responsible charge of the truss design, but does approve the design criteria to which these
components were designed.
32
I
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification:
Occupancy Group:
SINGLE FAMILY DWELLING
51-820 AVENIDA MADERO
R-3 Type of Construction: VN
Owner of Building: NEAL T. BAKER ENTERPRISES
Building Official
Bldg. Permit No.: 0107-161
Land Use Zone: RC
Address: 1875 BUSINESS CENTER DRIVE
City: SAN BERNARDINO, CA 92408
By: RICHARD KIRKLAND
Date: 05-16-02
POST IN A CONSPICUOUS PLACE
T 6 0
4ht 4 4 a"
Building 51-835 Ave. hadero
Address
Owner Ralph Murbach
mailing
Address Sa=
City Zip
La Quinta, CA 92253
�
,6m Roofing
0 Rancho Los Coyotes
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST.
A.P. Number
Legal Description
Project Description Reroof
Cit Zip CA zlp 92201 Te1.345_3751
State Lic. City
& Classif. C-39 625038 Lic. # 12
Arch., Engr.,
Designer
Address I Tel.
tyI Zip I State
Lia #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70®0) of Division 3 of the Business
♦and Professions Code, and my license is in full force and
SIGNATURE ✓ DATE
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).
❑ 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.)
❑ 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
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 o. Company
❑ is filed with the city. ❑ 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: If, alter 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.
I certify that 1 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
No. 13803
_OCC. GRP.
Minimum Setback Distances: ` I
P;
Front Setback from Center Lin
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line µ
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$3*200.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
30.00
Mech.
Electrical
Plumbing
.S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
30.00
Minimum Setback Distances: ` I
P;
Front Setback from Center Lin
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line µ
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
2ND FL. S0. FT.
FORMS
YARD SPKLR SYSTEM
FOR. S0. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. p
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
OTHER APPJEOUIP.
DRAINAGE PIPING
WALL SO. FT.
TEMP. POLE
DRINKING FOUNTAIN,
SO FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
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
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
SPARK ARRESTOR
SO. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LATHING
SO.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 FEF7 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