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AR (15119) + RPL (11329)44400 Marigold Lane 15119 11329 P.O. BOX 1.504 N o . Buildin 44 400' LA DU NTA, CALIFORN8-495 CALLE IA 92253 Address Owner • 4 . JME5 HARBARIA .DALLA Mailing BUILDING: TYPE CONST. OCC: GRP. Address 141 WHITE ®.K DP: A.P. Number City Zi IT9-1.18-355-9135 .. .- . R A CjA 51€ 06 Legal Description Contractor. GWN&R BW 9_9 R Project Description`BOWS, a0 ' t= 'I0 Address . , Cit Zip Tel.: State Lic.: } City jj Classif.. Lic..# C Sq. Ft.' a No. " " No. Dw. Size • • JM ..Stories. Units .Arch., Engr., Designer New ❑ Add:O .. Alter p Repair O Demolition ❑ Address, Tel. >Cityt Zip State ; Lica# • LICENSED CONTRACTOR'S DECLARATION ' n r I hereby affirm that I am licensed•under provisions of Chapter 9 (commencing with Section ♦ _ 7000) of Divi si*o 3 _,Wh BuSfness rfd Pro fessions ode, and ;license is in fault force and effect. .,SIGNATUREr DATE 't ' OWNEWBUILDER DE `RATION Estimated Valuation " I herby affirm. that I am exempt from the Contractors License Law for the.following ,treason: -(Sec.. 703115; Business and Professions Code:- Any city,or county which requires a *Q •,:; 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 '' t; the pioJlsions of the Contractor's License Law, Chapter 9 (commencing with Section, 7000) -of - ' ;'• Divislon 3 of the Business and Professions Code, or that. he'is exempt therefrom, and the basis . ;,for .the allegedipxemptlon. Any violation of Section 7031.5 -by 'any applicant .for a permit Plan Chk. Dep. - _ • - -'subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).."0101 •''0.1, as owner of the property, or my employees with.wages as their sole compensation, will. Plan'Chk.,Bal. • 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 COf1St.•_•, ` 0 +builds'or improves thereon and who does such work himself or through his own employees, ;Mech. " 4 - `provided that such improvements are not Intended or offered for sale. If,. however, the building 'Of improvement Is sold within one .year of completion, the:. owner -builder will have the burden • - Electrical 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- r Plumbing struct the project., (Sec. 7044, Business and -Professions Code: The Contractor's License Law does not apply td,anowner of property who builds or improves thereon, and who contracts for S.M.I. ' such projects with's contractors) (kensed pursuant to the Contractor's License Law.) O I am exempt under Sec. ` B. 8 P.C. for this reason Grading Driveway -Enc. -'Date' Owner, Infrastructure - r WORKERS' COMPENSATION DECLARATION ry 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.t3800, Labor Code.) ' Policy No. Company , '• . ❑-Copy is filed with the city, ❑ Certified copy is hereby furnished: TOTAL TC & U CERTIFICATE OF EXEMPTION FROM REMARKS! WORKERS'COMPENSATIONINSURANCE '(This section need not be completed N the permit is for one hundred'dollars ($100)' -valuation. or less.) r - 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 ' o/ Exemption you .should 'become.. ZONE: BY: - subject to the Workers' Compensation provisions *of the Labor Code, you must forthwith MIf11R1UmSetbaokDlStancesi comply with such provisions or this permit shall be deemed revoked. - - - :. Front Setback from Center Line Rear Setback from Rear Prop. Line WARNING: FAILURE TO SECURE WORKERS'COMPENSATIONCOVERAGE ISUNLAWFUL, AND . Side Street Setback.frornCenter Line SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($11X1,000), IN ADDITION TO THE COST•OF COMPENSATION, Side Setback from Property Line: DAMAGES AS PROVIDED FOR IN SECTION 3706.OFTHE LABOR CODE; INTEREST; AND ' ATTORNEY'S FEES. - `This Is abullding permit khen.properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR expiration if work thereunder is suspended for 180 days: I certify that I have read thisapplication and state that -the: above information is correct.*, ` Is bed by Date' Permit a'ree 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•. i mentioned property for inspection purposes., Validated by: ,-Signature of applicant Date Mailing Address ' Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIWU FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. p POR. SO. FT. ® GAR. SO. FT. ® CAR P. SO. FT. WALL SQ. 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 SLAB GRADE FLOOR DRAIN MECHANICAL FEES ROUGH PLUMB. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED DUCT WORK 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® IIA c SEWAGE DISPOSAL BOND BEAM SO.FT.GAR p 3/ac HOUSE SEWER WATER SYSTEM GRADING cu. yd. $ plus x$ 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 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 ` \\IJ REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL _Rivicu►e 7 am l anc Res' 'ential (Daae) or 22)CF-1 R Date .oject Title , oject Address Building Permit a • "/ /} n i= LL EN L- F2!` r2 3ED'" S Plan ChecK i Date ocumentation Author Telephone • Field Check i Date ampiiance Method. (Pac age. Point Svstem or Computer) Climate Zone' cnlorcoment Agoncy Use Unly !ENERAL INFORMATION otal Conditioned Floor Area: 2qd ft2 3uilding Type: Single Family V Addition -heck one or morel Multi -Family Existing -Plus -Addition :vont Orientation: 2 0 North / East / Southes All Orientations (Input onentation in degre d cirde one.) Vumber of .Dwelling Units: =1oor Construction Type: Sla /Raised Floor (circle one or both)' BUILDING SHELL INSULATION Construction 3omponent Insulation Assembly. Locatiort/Comments Type R Value U -Value (attic to garaoe: typical, etc.) Wall .............. 2 l3 i • u% u.' Wall ..............' Roof ......:...... ,f✓ IV Roof ............. Floor ............. Floor ............. Slab Edge .... FENESTRATION Fenestration Area Orientation (sf) Front .... wi`) Front...:.( ) Left ....... (t4— Left...,... Rear :.... ( ) Rear ..... ( ) Right..... ( ) ',Right..... ( ) Skylight ....... Skylight ....... Fenestration U -Value THERMAL MASS Type/Covering Area (slab/exposed. tile, etc.) (sf) U Revised January 1992 Shading Devices Interior (roller blind, etc.) 06 w. Exterior etc.) Overhang Framing. Type (Ves/no) (metaltwoodNinyl) Thickness (inches) Location/ Description (kitchen. barn. etc.) u Certificate of Compl- liance: Residential (Page 2 of 2) CF -1.R Project Title Date HVAC SYSTEMS Note: input hy dronic or combined hydronic data under Water Heating Systems. except Design Heating Load. Heating Equipment Minimum TDistribution ype and Duct or T(furnace,heat ype Efficiency Location Piping - Thermostat Cooling Equipment Minimum Duct Type (air condhion'er. Efficiency - Dumo, evao. coolino (SEER) Location Duct Thernostat. Configurationheat . (attic. etc.) R -Value T11111pe (split or package) WATER HEATING SYSTEMS Water Heater Distribution Number Rated' Tank Energy External Fa[ctor Tank Input (kW Type Tuna in Capacity Recover ry Standby' Insulation(ga. s) Efficiency Loss (%) R -Value 1. For small gas storage (rated input S 75.000 Btu/hr), . electric resistance a . rid heat PUMP water healers. list Energy Factor.I For large gas storageter hooter* (rated input a 75,000 Btu/hr). list Rated Input. Recovery Efficiency and Standby Loss. For . I . nstantaneous gee water heaters, list Rated Input and Recovery Efficiency. SPECIAL FEATURES/REMARKS (Add extra sheets if necessary) COMPLIANCE STATEMENT This certificate of compliance lists the building features and performance specifications needed 10 Comply with Title 24, Parts 1 and 6, of the California Code of Regulations, and the administrative regulations'to implement them. This certificate has been signed by the individual voth overall design responsibility. When this ceniticate of compliance is Submitted for a single building plan to be built in multiple orientations, any shading feature that is varied is indicated in the Special Features/Rem arks section. Designer or Owner (Per BusinOsa'& Prof0asions 'Code) Name: Title/Finn: Address: ------------ Telephone: Uc. S: (signature) (date) Enforcement Agency Name: Tide: Agency: Telephone: (signature/stamp) (date) Revised January 1992 Documentation Author 4P Name: Tide/Firm: Address: 79 =12 I Cc* 44 A- C7, Telephone: 61 C- C- C-0, r (Sig r (date) (sig I ozs O A Z yZ ' I n .P "or S ti a Al 0. oIlk 0 C I . aaw na o e' p00 th F a o, I n .P "or S ti a Al 0. 0 C I I n .P "or S ti a Al C I I n .P "or S P.O. BOX 1504 N o . 11329 Building 44-400 Marigold old 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner Tim Dallas Mailing BUILDING: TYPE CONST. • OCC: GRP. Address same as above A.P. Number City Zip Tel. La Quanta .92253 345-9 Legal Legal Description Contractor y Pool and Spa Project Description Pool and Spa valle Address 4741 C E. Pala Canyon City ]ZIP Tel.: t P.S. 92264 778--3939 State Lic. City & Classif. A 359105 Lic. # 2565 Sq. Ft. No. No. Dw. Arch., Engr., Size Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 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. / _SIGNATURE '- ., DATE OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that 1 am exempt from the Contractor's License Law for the following l4© 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, r 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 for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for `a permit Plan Chk. Dep. subjects the applicant to a civil penalty o/ not more than rive hundred dollars ($500). O I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 99 . 45 do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 5 . fl Professions Code: The Contractor's License Law does not apply to an owner o/ property who builds or improves thereon and who does such work himself or through his own employees, Mech. Z 4• Q provided that such improvements are not intended or offered for sale. I/, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden Electrical a of proving that he did not build or improve for the purpose o/ sale.) • ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 27. 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.1. Q such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading 1. ❑ I am exempt under Sec. B. 8 P.C. for this reason Driveway Enc. Date Owner Infrastructure s WORKERS' COMPENSATION DECLARATION 1 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 O Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL - • 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 an ff,7fter manner o as to beccOmee supject to the Workers' Compensation Laws of California M Date Owne. NOTICE TO APPLICANT.making this CeRifI to o/ 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 100 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 Dale Mailing Address City, State, Zip REMARKS . t'.)'# a TT 1, 14Ittrlfir - 1," 4)4'1 e.D 'fit 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 Perm Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEE' 1ST FL. SQ. FT. ® $ 2ND FL SQ. FT. POR. SQ. FT. ® GAR. SO. FT. ® CAR P. SQ. FT. WALL SO. FT. ® SQ 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 ROUGH PLUMB. FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GAS (ROUGH) LAUNDRY TRAY 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. SQ. FT. ® c BATH TUB BOND BEAM SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ec 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) 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 ` s // ✓ [// //GJ/ C REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Building Address Owner Mailing Address }. City P.O. BOX 1504 No. 05892 Vii^ i Marigold' >r+ 7&105 CALLE ESTADO . LA QUINTA, CALIFORNIA 92253 La Qtdu a'A,8$ielistes - BUIL'DING:'TYPE'CONST. OCC`GRP. 43"-8X5 8SIngton St.. A.P. Number Tel. Te ._ .. Phase' Z Lot 43 92260 "" Legal Description or, Project Description PIM 2B Cfit<sv8 Flower EX. Williams Dev. Cam g Sam Date Owner Infrastructure + WORKERS' COMPENSATION DECLARATION State Lic. City I hereby affirm that I have a certificate of consent to self -insure, or a certificate of workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) s. & Classif. 493919 Lic. # 11,231 Sq. Ft. _ No. No. Dw. Size' -. 1621 ;F -Stories' .-Units Arch., Engr., •- - TOTAL - Designer New Add ❑ - Alter ❑ Repair ❑ Demolition ❑ Address Tel. .,►'tit^ i ; f:K 1:.• -s ri . sv ' ' .6 ° i74 v:1 V a + P e - or ' or less.) I certify that in the performance of thg work for which this permit is issued, I shall not, City.. Zip State Laws of California. ^ Lic. # ' Date --L- . ' Owner ' LICENSED CONTRACTOR'S DECLARATION NOTICE TO •APPLICANT. Q after makig this Certificate of Exemption you should become 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section BY:` subject to the workers' Ccepensation Provisions of the Labor Code, you must forthwith •Comply With Such Provisions mOesPemrashanbedeemed revoked . , _•;:70011) of Division 3 of the Business and Professions Code, and my license is in full force and effect f ,.. : SIGNATURE - ^' - DATE ^ Rear Setback from Rear Prop. Line . OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that there is a construction lending agency for the performance of the hereby affirm that I am exempt from the Contractors License Law for the following reason. 7031.5,Busimess Any 'a -.;` Sq+ . ! _ (Sec. and Professions Code: city Or county which requires permit to construct, ader, wrprove, dernofish'or repair any structure, prior to its issuance also Side Setback from Property Line 9 --Ares the applicant for such permit to Me a signed statement. that he Is licensed pursuant to - PERMIT; AMOUNT the provisiars..of the Contractors license Law. Chapter 9 (commencing with Section 7000) of. INSPECTOR« ' expiration it work thereunder is suspended for 180 days. I certify that I have read this _v. Division 3 of the. Business and Professions Code, or that. he is exempt therefrom, and the basis fir the alleged exerrpOvn. Arty vialalion of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep. - - subjects the appfipnt to a Cvr7 penalty of not more than five. hundred dollars ($500). Plan Chk. Bal. - ,r , ; > .488 77 ❑ 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, Suisness and Professions Const. Code: The Contractor's License Law does not apply to an owner of property who ' bud& Or improves thereon and who does such work himself or through his own employees, Mech.' • 4' . .. , 9 Provided that'surh emproverrnents are not intended or offered for sale. If, however, the building _ . -V - or improvement is sold within are year of completion, the owner -builder will have the burden^•'• .. of proving that he did not build or improve for the purpose of sale.) - EI ect rl Cal - _ • ,•; n lar N 0 ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 123 :aV . • f` r 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. 1.such •C projects with a contractor(s) 8oensed pursuant to the Contractor's License Law.) Grading ❑ 1 am exempt under Sec_ B. & 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, or a certificate of workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) ' Policy No Company O Copy.is filed with the city- ❑ Certified copy is hereby furnished. TOTAL s • 3330.00 i CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE „ REMARKS a _ n r '. 4 ,• a s ,, . r ti «. x x r '' 4 sermon need not be le carpM.ted i1 the permit is for one hundred dollars ($100) valuation ' .,►'tit^ i ; f:K 1:.• -s ri . sv ' ' .6 ° i74 v:1 V a + P e - or ' or less.) I certify that in the performance of thg work for which this permit is issued, I shall not, : 4 - employ any person in any manner so as to become subject to the Workers' Compensation., Laws of California. ^ ' Date --L- . ' Owner NOTICE TO •APPLICANT. Q after makig this Certificate of Exemption you should become ZONE: BY:` subject to the workers' Ccepensation Provisions of the Labor Code, you must forthwith •Comply With Such Provisions mOesPemrashanbedeemed revoked . , - - Minimum Setback Distances: - Front Setback from Center Line ^ Rear Setback from Rear Prop. Line ' CONSTRUCTION LENDING AGENCY $lite Street Setback+from Center Line F 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 Lenders Name Lenders Address ' This is a building permit when property filled out, signed and validated, and is subject to FINAL DATE INSPECTOR« ' expiration it work thereunder is suspended for 180 days. I certify that I have read this i ' application and state that the above information is correct.ISSUed ' 1 to by: Date Permit- agree 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 - CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ UNITS SLAB GRADE7 OUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL SQ. FT. 71111 FORMS SEWER OR SEPTIC TANK ROUGH WIRING. MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® AS (ROUGH) ` 1 'L ETER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) (y '?WP. POLE DRAINAGE PIPING CAR P. SQ. FT. GROUT WATER HEATER WALL SQ. FT. FINAL INSP. DRINKING FOUNTAIN. SQ FT ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ _$ WATER PIPING NOTE Not to be used as property tax valuation ROOFING q r--Mr VENTILATION FIRE ZONE ROOFING ' FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING f' MESH INSULATIONISOUND (,0 k FINISH GRADING tt FINAL INSPECTION CERT. OCC. .C.rC MUM 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 SQ. FT. ® c WATER HEATER MAX HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® V4c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE tL.CK.FEE 7ONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING_ ^ ELECTRICAL HEATING & AIR COND. SOLAR 4W SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE7 OUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK 71111 FORMS SEWER OR SEPTIC TANK ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF.,6/ AS (ROUGH) ` 1 'L ETER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) (y '?WP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _$ d LUMBER GR. FINAL INSP. T 2®P FRAMING 10(71-tFINAL INSP. ROOFING q r--Mr VENTILATION FIRE ZONE ROOFING ' FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING f' MESH INSULATIONISOUND (,0 k FINISH GRADING tt FINAL INSPECTION CERT. OCC. .C.rC MUM REMARKS: SIGNATURESIINITIALS GARDEN WALL FINAL