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BLDG (0203-421) + PLBG (13093) + PLBG (10799) + PAT (10697)
52215 Avenida Madero 0203-421 13093 10799 10697 LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed .Uncler 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. Class Exp. Date t . Date Signature of Contractor OWNER -BUILDER DECLARATION I here¢y.affirm. under penalty of perjury that I am exempt from the Contractor's License, Law for the following reason: ( ) ;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, Business & Professionals Code). 1, 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 thi reaso Date: T-`., Q- QQSignature of Owner 4 - el-. .` n. t 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 by5 Section 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: Carrier Policy No. - (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,beccome subject to the workers' compensation laws of California, and agree that if,;l should become subject to the workers' compensation provisions of Section 3)Tk,! 4__ of the Labor Code, 132 I shall forthwith comply wi h those provisions. t Date:+,O_V-.1 Applicant _,..,--)4"AA,ex p Warning: Failure to secure Workers' Compensati coverage is unlawful and shall subject an employer to criminal penaltiesanted. vil 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. E 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 withall City, and State laws relating to the building construction, and hereby authorizes representatP6s sof this City to enter upon the above-mentioned property for insp ction purposed Signature (Owner/Agent) _ e Date - r `. PERMIT # UILDING PERMIT. A...-.- .020:§-42 _.ZI DATE VALUATIONLOT TRACT JOB SITE ADDRESS 52_2.15 Ai .l<.N 3i1li}rf .C t APN OWNER CONTRACTOR/DESIGNER/EN (NEER D0110 DIMUP ' ow -WAS. - si.I:[Lx+j R 52+.21:5-Av I?A17i3P:Ni pxo LA I3IM.-A t ` ..A, Sp2 ,, USE O rrFFy PE R {M IIpTy p qq^ yggry q p Cpy r ` i [V.L: RJ L J 1111..a6J.LiV 1.7 I 15 r. e, 6, woof) Irn-Tcy- F 6 Fri WOOD Fr, M11S." 'LP X5n1 1`aTED 0' 0b"r W Ml'di"'.'I'.1 UMiiON 97'j 1Y.1 CONSTRUCTION PEP, 101-000-418-000 f; UWTOTAL C"0149 7 _YJ(° T kT AND YLAIT X19,,' K S25.00 :CCP AL PERMU3' f' WS 1A,% N0W yyRECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final St' Waste Lines Water Piping Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure r Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final 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) COMMENTS: OWNER/BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as ''Owner/Builder" you are the responsible party of record on such a permit. Building permits are not -required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the City or County. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefii and protection: If you employ or otherwise engage.. any persons other than your immediate family, and the work (including materials and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may bean employer. If you are an employer, you must register with the State and Federal Government as an employer,and you are subject to several obligations including State and Federal income tax withholding, federal social security taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions. `. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect, to worker's compensation insurance. For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through, their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally.. Building permits are not required to be signed by property owners unless they are performing 'their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N. Street, Sacramento, California 95814. Please complete -and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La •nta, C0 92253 (760) 77 012 F (7G017-70 } _ 1 Ovk SIGISi'A' URE/DATE M CN DIE 1 y8v PROPERTY ADDRESS PERMIT NUMBER(s) j c• - Building'-` Address ` 5.2 Madero ` p - ti t.•- r.. ;,,. - 'ysx {Z ' .. . .» - _ i P.O. BOX 1504 N o . 1.3093'"..; 78-105 CALLE ESTADO .LA QUINTA, CALIFORNIA 92253 Doug Diemen BUILDING: TYPE CONST. OCC: GRP. - Mailing. _ Address -Se; Me A.P. Number City Zip Tel. J Tse1iltc CA 9223 Legal Description •Contractor.'. k' -up Sewer HOO - Project Description Hendrickzidn Ccustruction Address 68 31 .,;Kieley Road City t ';':: Zip TeL: , . Cath 41, Citi o CP •, M34 328-1747 State Lic -y:=, _' City & Classlf t 256184—A Lic. # Arch-'EngrT. .'. < Sq. Ft. 'No. Size Stories r New ❑ Designer - •' AddTel.,, City 1 r , Zip State - Lic. # LICENSED CONTRACTOR'S DECLARATION' I hereby affirm.that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Divi/sJ'o!n 3 of tth e •Business and -Professions Code, and my license is in full force and • -effect , J =` fi .d SIGNATURE S'• ••'•: - V DATE w f ,I' `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, i 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 penally of not'more than five hundred dollars (S500). ❑ 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.) 1 ' 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 . • r Date r' ` Owner WORKERS' COMPENSATION DECLARATION s 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.) Poli cy o Company f T opy 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 (8100) valuation or less:)• II 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. _-Owner 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 •' 1 hereby affirm that there is i construction lending agency for the performance of the whic work for h this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address Thii 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 . ,rr No. Dw s Units •c Add ❑ '. Alter ❑ Repair.❑ F';`Demoljtion ❑ k 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: Estimated.. Valuation $1,590.00 i -^r r" ix PERMIT AMOUNT., Plan Chk. Dep. , Plan Chk. Bal: Const. Mech. r Electrical Plumbing10 t1u3 .S. M. 1. Grading Driveway Enc. Infrastructure :r TOTAL , • u° REMARKS k 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 IST FL. SQ. FT. ® $ UNITS SLAB GRADE y 2ND FL. SQ. FT. BONDING YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. Q. FT. p GAS (ROUGH) DRAINAGE PIPING WALL SQ. FT. 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 FINAL INSP. 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL GAR. FIREWALL SQ.FT.GAR ® 3/ac HOUSE SEWER LATHING 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 0"-6&R=—L4"7 3ROUGH 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 INSULATION/SOUND FINISH GRADING FINAL INSPECTION J CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Bujldjss ' Ad Sress52-215 MADERO Owner DOUG DELOTA Mailing Address SAME City Zip LA QUINTA 92253 Contractor RVS PLUMBING T41Y 4 P.O. BOX 1504 l i1 •N Q. 10799 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 BUILDING: TYPE CONST. OCC: GRP. - el. -- - P 0 BOR 692 City Zip Tel-: RANC90 MIRE GE 341-6546 State Lic. City &Classif. C36./602396 Lic.# 1914 Arch., Engr., Designer Address Tel. City Zip State Lic: # LICENSED CONTRACTOR'S DECLARATION I heeff6crebyy affirm that I a Itcense nder p ovisions of Chapter 9 (commencing with Section 7000)=of,R'is of n 3 of t Bus•ness and Pr6fesstons,Code-and my license is in full fort and SLGNATURE / 1 !-' i 1 } n.C 1/ DATES -e OWNER9U LDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following 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 8s issuance also requires the applicant for such permit to rile 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, of 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 knprove for the purpose of sale.) ❑ 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, .are certified copy. thereof.. (Sec. 3800, Labor Code.) Polio No. Company ' &Copy 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 the work for whit .thi"s perm(t is issyed,l•shall not employ any pperson in any manner=s as. o becom6 sub ect to the'INork, efS' Compensation Laws of•Californiaq _TJ'j";rke do Date ! % < 9w Qc 7 "Y 1 C) •t 1, Oztm NOTICE TO'APPUCAA'T: 1 .aRer mdkng rsv Ce&rtdroate o €xemW trZn 'y6u shoWr% bet mo e subject to the Workers' Con)entionProvishovis 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 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 Number Legal Description Project Description APPLIANCES QAS PIPING SERVING 3 Sq. Ft. Size • No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $500 PERMIT ' AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing $30.00 S.M.I. Grading Driveway Enc. Infrastructure TOTAL $30.00 REMARKS yyi.'W.•.::. Y, iarY.: YSY `.': . GYY}'Yi:i.'us , w} r a -'I!'V 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: Validati CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL SO. FT. ® POR. SO. FT. ® GAR. SO. FT. ® CARP. 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 FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM HEATING (FINAL) 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 BOND BEAM SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1 Vic SEWAGE DISPOSAL LUMBER GR. SO.FT.GAR ® 3/ic HOUSE SEWER FRAMING FINAL INSP. 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) L/ [[[ 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 INSULATION/SOUND FINISH GRADING oc FINAL INSPECTION 2' CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL P.O. BOX 15(k _ -No 146 9 7: Building7&105 CALLE ESTADO Address 52"'22.5 Madero LA QUINTA, CALIFORNIA 92253 'Owner Dougla$` iiemer ' RtIILnilNG--.TYPF CONST_ _OCC' r;RP Mailing Address same City Zip Tel. LaQuin a 92253 564--0982 Contractor 'Universal Construction Address . .' 1440 S. State Loilege #3F -City Zip. Tel.: • A.P_ Number Legal Description Project Description Enclose -existing wood- patio. waver wit screen & acrgrlic.; ,,E-JeCtr* C ax;UVV rays —ants sr 2 recti tacles K 2 swatches State Lic. •City & Classif.'. B 595317 Lic. # g92g Size Sq_ Ft. NO. Arch.; , - 28.$ - - ._-Stories Engr. -• - Designer - _ New ❑. Address Tel. City Zip' State Lic. # LICENSED CONTRACTOR'S DECLARATION _ I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section - 7000) of . Professions *Code, is in ,i. SIGNATURE R v unJ - - - DATE . _ .. .. .. ' OWNER L .2 BDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec.. 7031.5,Buslness and Professions Code: Any•cdy or county which reuluires a pro9 Pvin u sale) Estimated Valuation. ` .(3 7.12 • 80 - permit to construct, atter, Improve, - demolish, or .repair any structure; prior to its issuance also • - requires the applicant for such permit to rile a signed statement that he is licensed pursuant to • - - - PERMIT, 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 . exemptlon.-Any. violation of Section 7031.5 by. -any applicant for a .pend. - - - -Plari•Chk. Dep. • - subjects the Applicant to a civil penalty of not more. than five hundred dodars'($500)- y-; _ - ; ❑. 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, Busness and Professions Code:.The Contractor's License.Law does not_apipty to an ownerof properly who plan Chk. Bal. - COrISt. 1111 ech • •. builds or Improves thereon and who •does • such. work himself or through his. own: employees, provided that such improvements are .not Intended or.oHered,for sale. f, however,.the budding or improvement is said within one year of completion,. the owner -builder wig have the burden, Of that he did not build of im rove for the e of 'Electrical I ' - O 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. Contractors License Law aP does not ply to an owne of erl hob Ids ves th and who' /o S I' r prop y w um or mmpro ereon, conlra s. r - such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -M.. - - .. 40 ' Grading • ❑.I am exempt under Sec: B. 8 P.C. for this reason _ _. ' Driveway Enc. Date Owner Infrastructure _ WORKERS' COMPENSATION DECLARATION ' I hereby affirm that I have 'a' certificate of consent to self -insure, ora certificate of ` Worker's Compensation Insurance, or a certified copy thereof. (Sec. 9800, Labor Code.). Policy No " 'Company ❑ Copy, is filed with;the city. .❑ Certified copy is hereby furnished., - - TOTAL 0.051'a9- 135347 _01-0-92 ._A 0 CERTIFICATE OF EXEMPTION FROM`. REMARKS ) {i T.1164i t .A - L I "L. J. k s 7 A Q.Q.1111. WORKERS' COMPENSATION INSURANCE (This section neednot be completed 9 the permit is for one hundred dollars ($100),vahtlGon • - { ". - or less.) .., .. ' I certify that in the performance of thg work for which this permit is issued, I shall not" ir ' - employ any pperson in any manner n so as to become subject to'the Workers' Compensation ' Laws of Cal 0 nia. 'Date .. ` ' ° Owner ' NOTICE TO APPLICANT:If, after making Chir• Certificate of Exemption you should: become' -the ZONE: BY: subject to Workers' Compensation provisions of .the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. - - - 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 perfomtance of the , work for which this permit is issued. (Sec. 3097, Civil Code.) ` r . '- 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 Permit- - I agree to comply'with all;city and county ordinances and state laws relating to building construction, and hereby authorize representatives .of this cityto enter the -.above -.`- mentioned property.for inspection purpos s. n Validated by: Signature of applicant-: },. ; '' Date Mailing Address Validation:_ - City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. POR. SO. FT. ® GAR. SO. FT. ® CARP. 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 WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) / l GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRYTRAY 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 ® 11A c SEWAGE DISPOSAL K/ 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) / l 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 C.5 -1,w FINAL INSP. ROOFING K/ REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION- NSPECTION CERT. OCC. CERT. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL ----' ; '^T --d-•"---y-^--h---- "` -- - . -r- IT i.hil-' SAFE-tTY n PARTMENT --- - EP3E 3 C STRU `TiON- - - ' SUS;SECT-TO`I 3S7AL-CATION AS PEfi ' - t^- *1#- :_. ` '-.--- -FST--r✓ .` ' .;,1z _I,CfJ ., I "1 1 i i . _ . SAND ALL APPLIC6 BLECODES I i DATE . _ -"r- "-^T' -" - `- , C+-. Vr`-" -•,----i•Ts--- ' *-+- "----" .': ....." _p...._.^r__. _.._......y.. ---r ,-- ....r-...._.'.,.-- _- t.. _.-t _... r' _ - f1j -h•-- -- ^'--4-. ' ` t- -•- 1 •tj}-=->---i=1- .., = _ . t ; . 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ES._EVPLIir llUt•,FiEFOP.TNo.2(o2IP ' RevI51oN5 19 ALW" BUILDING PRODUCTS {% IEVALLI.AlON 11 BY¢noa?rgo4C1 DEVELDOUEN r AND ENDINFEPING FLUMINUM _ E_ ,ew......o t /•pOEp Cr^ -j Trr uw n: c use `_ Wa-. F.1_ G. µO. .,IO CT}'{ w°Ail wl . 3Dot— R F x es u6c'/gj . : c ENCLOSLIR S 4 -IB a4: • • . Him ffg. HNIM HAM moms • m® memo0 os © I• E 1 • • Lima mmem• Mosm • • Esm MINIM KUM Ems- usFet4 pep Gro LI WA 60t446c-Tog-. 2 55087 k=::cisTINC .1;,2'X% Z I10 .6 O LVP. Pi, -lo ,_icrLleE 3.-00" oIo a P x 70° TV(2. i. 1105" L..1V.J c"ti IN( IBX. Z.ZIO iclf O aoTTdM c-44p-Nt,tF=i—Gu-lJM "5 15) dLJ ' guun R+vErs ' 18" Oma. i YP ILiflti .. ExI ST nIG- L., x: " QF LARca-1 #12 MiQ. I. t Et a-oe lJl p_ Fuu -A F E.XI jTIYJ(a kL't7 S(LL-1GTlJ(CFi %N 'R °+0 I.o'I oqt i P. % LvziN I I `2 Net -(/-,-U i 60((j-T( ) SU Nn _ , I FJ-EGTk CF1 GNf E _ II551. 1" C•OIJNEGTO♦` E C . 44n —7-7 TOS T -CBO. ES._EVPLIir llUt•,FiEFOP.TNo.2(o2IP ' RevI51oN5 19 ALW" BUILDING PRODUCTS {% IEVALLI.AlON 11 BY¢noa?rgo4C1 DEVELDOUEN r AND ENDINFEPING FLUMINUM _ E_ ,ew......o t /•pOEp Cr^ -j Trr uw n: c use `_ Wa-. F.1_ G. µO. .,IO CT}'{ w°Ail wl . 3Dot— R F x es u6c'/gj . : c ENCLOSLIR S 4 -IB a4: