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BLCK (10-0542) + PAT (10821) + RPL (10771)44555 Marguerite Ct 10-0542 10821 10771 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA,-CALIFORNIA 92253 Application Number: 10 --OA 000.5-4.2...,; Property Address: 44555 MARGURITE CT APN: 604-252-038-58 -24208 - Application description: WALL/FENCE Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 375 ' BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Applicant: _ Architect or Engine ----------------- LICENSED CONTRACTOR'S 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 Class: C29 License No.: 804168 q Date: Contractor - OWNER -BUILDER ECLARATI I hereby affirm under penalty of perjury that I am exempt from the actor's tate 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).: 1 _) 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.). (_) 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.). ( ) 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.). Lender's Name: _ Lender's Address: LQPERIIIIT Owner: RODRIGUEZ PAUL 44555 MARGUERITE CT LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-701.1 INSPECTIONS (760) 777-7153 Date: 6/21/10 0 Contractor:._... ....., ! ...... . ---~ - - AA MASONRY lEj:7u! 177530 DELAWARE PL1,1 LG ,PALM DESERT, CA 92211 `E(760)360-7388Lic. No.: 804168 CyofLAQU1NTA !( r_ E *11" ----------------------------------------------- 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 ARCH INS Policy Number 03DKZM12003 _ 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 • 700 of the Labor Code, I shall irth t comply with ho ovisions. -Date:. (/ Applicant: - WARNING: FAILURE TO SECURE WO KERS' COMPENSATIO COVERAG S UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL 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 cou ty to nter upon the above-mentioned property for inspecti pu oses. Date: ` D Signature (Applicant or Agent): Application Number . 10-00000542 Permit WALL'/FENCE PERMIT ' Additional desc . Permit.Fee•15.00 Plan Check Fee .00 - ,, Issue .Date .. Valuation . . . . 375 Expiration Date 12/18/10 Qty Unit Charge. Per Extension' BASE FEE 15.00 Special Notes and Comments ` TOTAL OF 15 IN FT X.6 FT HT (2) COLUMNS BLOCK WALL•PER-CITY STANDARDS & APROVED "PLANS`:- ALSO 15 LN 'FT -AT •2" -FT -HT"----' -` '-' PLANTER. ` ------------------------------------------ Other Fees ". BLDG STDS ADMIN,(SB1473) 1.00 t Fee summary. Charged Paid Credited Due ---------------------------------------------------------- Permit Fee.Total 15..0.0 .00 .00 15.00 Plan Check Total. .00 .00..- .00 .00 . Other Fee Total 1.00 .00 .00 1.00 Grand Total .16.00 .00 .00 16.00 •:, LQPER111IT _ ° Bin # City of LQ Quint Building 8L Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # l0 ' Project Address: 5S t, C, Owner's Name: A. P. Number: Address: -655 i/ Legal Description: City, ST, Zip:. Contractor: Telephone: Address: _ ` Project Description: L City, ST, Zip: r µ.:,..;::::......;s:::... Telephone: // 6 :,.:::..l / State Lic. # 9 n City Lic. 9:6 q f Arch., Engr., Designer: Address: City, ST, Zip: Telephone: }':j:?.; '{S•:riy:if}S: N{yi:'ji:4 S\fiSivti:S::Z ::>'F;•: '::: <. .>.:;<;:>.«.>::-.:•:<, .>: ; ; ::s ::: f,:. •%vi::;:v Construction Type: Occupancy: State Lic. #:"%'.: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: V Z Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: -Ll Ll 62 Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Tide 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2id Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.1. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 'i° Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees a ty 44 P.O. BOX 1504 Building _ 7&105 CALLE ESTADO Addrpcc 44-555 MARGUERITE '`.. LA QUINTA, CALIFORNIA 92253 Owner RAPKIN >, Mailing Address SAME r City Zip Tel. LA QUINTA 192253 Contractor ALLIE IPOOL Address 43-530 PALMILLA DR City Zip Tel.: PALM DESERT 92260 340-5474 State Lic. City w & Classif. Lic. # Arch., Engr., Designer 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 Division 3 of the Business,and Professions Code, and my license is in full force and effect. 11 _SIGNATURE f 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 rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or 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). E) 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 or property *who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 0 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. certifiedcopy thereof., (Sec. 3800; Labor Code.). Policy No. Company tCopy is filed with the city. .❑ Certified copy is hereby furnished. L 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 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 it 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 No. 14821 ILDING: TYPE CONST. • OCC: GRP P. Number Legal Description Project Description PATIO COVER 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: Validat Sq. Ft. Size • No. Stories No. Dw. -Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $2,000 PERMIT ' AMOUNT Plan Chk. Dep. Plan Chk. Bal. $40.95 Const. 63.00 Mech. Electrical Plumbing S.M.I. .40 Grading Driveway Enc. Infrastructure TOTAL REMARKS, 0105 7,AQ .9.1ZQ1 47t4f9lc. JA If, V 4 C9,J 11 W, t ly i ti4 ,Y 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: Validat CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ 2N0 FL. SQ. FT. POR. SQ. FT. ® GAR. SQ, FT. ® CARP. SQ. FT. WALL SO. FT. ® SQ FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM ti 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.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1% c SEWAGE DISPOSAL ,/, IC"! ' — • 5 I Sl( SQ.FT.GAR ® 3/ac HOUSE SEWER VENTILATION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PLCK.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. FRAMING FINAL INSP. ROOFING ,/, IC"! ' — • 5 I Sl( 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 Building 44-555 :Marguerite Address Owner Maur.iCe Ra kin Mailing Address City Zip iia Quinta 92253 Contractor .. 'Allied Pdol Address 43580 Palmijlla Cir P.O. BOX 1504 783105 CALLE ESTADO. LA QUINTA, CALIFORNIA 92253 No. '10771. BUILDING: -TYPE CONST. • . OCC: GRP. - A_P. Number Tel. Legal Description Project Description y Pool and Spa. Tel.: 340-54'4 State Lic. City & Classif. -053 542660 Lic. # ' 1540- Sq. Ft. No. No. Dw. Size .-- Stories• • Units Arch., Engr.- .: - Designer New ❑. Add O-- Alter ❑ Repair.❑ .- - Demolition ❑ Address Tel. r 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 Di ision Vof the Business and Professions Code,: and my license is in full force and lett. / • _ \/'SLGNATUREC _ _ DATE _ - OWNER -BUILDER DECLARATION. Estimated Valuation 'I hereby affirm that I am exempt from the Contractors License Law for the following the, •- . 13,500 reason: (Sec. 7031.5,Business and Professions Code: Any city or. county which a . - permit to construct, alter, 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 - • AMOUNT' the provisions of the Contractor's License taw, Chapter 9 -(commencing with Section 7000) of ' .' Division 3 of the Buslness and Professions Code, or that. he is exempt. thereliom, and the basis. for the alleged exemption. violation Section„7031.5 by.'any ' Plan Chk. Dep.. ,Any of applicant•for.a permit - ,subjects the applicant to a civil penalty of not more than rove hundred dollars.($500). - ' • ” _ , O I,.as the Plan Chk. - 99.45 owner of property, or my employees with wages as their sole compensation, will ` do the work; and the structure is not intended or offered for sale. (Sec. 7044, Baissness and Professions Code: The Contractor's Law _Bal., Const. '' 15 3 0 0 153.00- n ' .License does not, apply to an owner of property who builds or improves thereon and who does such work .himself or through his own employees, ' improvements intended for Mech. _ . - - ♦ f+ - - 2 4.00 . provided .that such ere not or. offered: sale. d, however,. the buDding. or improvement is sold within one year of completion,, the owner-bu8der will have the burden _ - Electrical' • of proving that he did not build or improve for the purpose of sale.) - _ 45.00 O I, as.owner of the property, am exclusively contracting with licensed contractors to con- - Plumbing 827.00 •• struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law- does not apply to an owner of property -who builds or improves thereon, and who contracts for S, M • I • • - ... _ - ;r •• - such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)- - .. .. Grading _ ❑ I am exempt under Sec. B. & P.C. for this reason •+ • .- Driveway Enc. - Date Owner Infrastructure ' 'WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 have a certificate of consent to self -insure or a certificate of • . Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) - fi"y(1'- : . _.$ F:::3? , % _' :c :—t`i•,4c^^t?` ,..i;..4 ', Poly No. Company 4 l.I4 Tt' i i f r 1 I'L. S =3 1 r. r„e.r 0 Copy is filed with the city. O Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM ` REMARKS WORKERS' COMPENSATION INSURANCE,. (This section need not be completed if the permit is for one hundred doilm (E 100) valuation ^ or less.) ' ' • • - I certify that in the performance of thg work for which this permit is issued, l 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: ti,- alter making this Certificate of Exemption--you-shoukf become 'to ZONE: - BY: - o . subject the Workers' Compensation provisions of the Labor Code, you must forthwith •' complywithsuchprovisionsorthis 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 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. ` . • __ 1 certify that 1 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 -ofthis city to enter the .above•. mentioned property for inspection purposes. Validated by: r Signature of applicant Date Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SO. FT. ® GAR. SQ, FT. ® CAR P. SQ. FT. WALL SQ. FT. ® Sp FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET r 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) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM TEMP. POLE 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 SQ. Fr. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1+/. c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ic HOUSE SEWER VENTILATION© 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 APPJEQUIP. 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 J `l 9 Y/v yp r/Q J //(/ ` A P2 REMARKS: VENTILATION© FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL f• t • Building Address 44-555 H= Owner Mailing Address City t^;T. == Contractor Address State Lic .. & Classlf. %$I p Zip s Q P.O. BOX 1504 No. 0830 ,. 78-105 CALLE ESTADO . COU", LA QUINTA, CALIFORNIA 92253. ' BUILDING: -TYPE CONST. OCC. GRP. A.P. Number T'AcS 242GS It ' ]Tel. • Legal Description ` Cneftift F314 rr " c_ m Project Description MR — 1.,n -t 58 7. ll MW 2B City . Lic. W ; i Sq. Ft. ..No. No. Dw. Size 1621 `: Stories Units Arch., Engr.; Designer New ❑ Add, ❑.. Alter ❑ Repair ❑ Demolition 0 ` Address Tel. -City Zip State t ... 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 reason, '(Sec. 70311tsiness and Professions Code:: Any city or county which requires a •-permit.to construct, atter, Improve, demolish, or repair any structure, prior to Its issuance also 't`Y •': requires the applicant for -such permit to rile a signed statement that he is licensed pursuant to *(commencing PERMIT , AMOUNT ^' the provisions o/ the Contractor's License Law, Chapter 9 with Section 7000) of, %•r Division 3 o/ the Business and Professions Code, or that. he Is exempt therefrom, and the basis the Any Section 7031.5 'any - - •. f,:. PIanChk: Dep.. `• _-for alleged exemption. violation o/ ,,__,Or by applicant for a permit - the applicant to a civil penalty of not more than live hundred ; dollars ($500)', as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.0.1, Q - do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and - Code: Contractor's Const. ,Professions The 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; that' improvements not intended - McCf1.- • - it~ . provided such are or offered for sale. If, however, the building or improvement is sold •within one year o/ completion, the owner -builder will have the burden . Electrical - - • a4n • of proving that he did not build or improve for the purpose o/ sale.) 1 iGl- 0 I, as owner of the property, am exclusively contracting with licensed contractors. to con- Plumbing struct the project. (Secy 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.W. _ 6.1 - 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. Infrastructure WORKERS' COMPENSATION DECLARATION„ . 1 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 .D Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM. REMARKS r WORKERS' COMPENSATION INSURANCE -, (This section need not be completed Il the permit is for -one hundred dollars ($100) valuation , q . r pt" ,p n a_'QdaQGl-l 4•+3"`7lf 55'.tif _405-14W or less.) - , I certify that in the performance of th'g 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 : '. 'ZONE: BY: subject to the 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 performance of the work for.which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line Lender's Name • r 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 city to enter the -above-,- ' mentioned property for inspection' purposes. ;.Validated by: ' • Signature of applicant Date' - Mailing Address- ,'Validation: . City, State, Zip . Lx n ..a'• ',. i.•'•' +,;. ?" z j :'^si p. -^+ . f'1,,,,(.} e] -d s -s •: " rY" 7,3 = 1.. •:r ; , ,,, . tis y r! 'C'1' f'¢ ,4 -'`''. , •..N:;. ,_r3 •w;ra • r >. Y ,., -.•- ..r.- +.;-#r , s . 3 .z'. . .. :•+ e .,qA r. f.. r-L .a `i ;...c..ti,z.i .. :t4•( .' r. CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ 2ND FL. S0. FT. POR. SQ. FT. ® GAR. SO, FT. ® CAR P. SQ. 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 STORAGE TANK FLOOR DRAIN MECHANICAL FEES DUCT WORK WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER REINF. STEEL GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM FINAL INSP. 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1+/4 c SEWAGE DISPOSAL FIRE ZONE ROOFING ' SO.FT.GAR ® 3/ac HOUSE SEWER FIREPLACE 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 ! I 146UNDERGROUND 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 "[ 7 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. r(lQ ( FRAMING U C (.h FINAL INSP. ROOFING 3 a q n J [ 1 q. < r l, (/ REMARKS: VENTILATION FIRE ZONE ROOFING ' FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING q L MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL