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PLBG (11-1240) + PAT (08205)79595 Marigold Lane 11-1240 08205 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: _11-00001240 Property Address: 79595 MARIGOLD' LN. APN: 604-093-012-38 -22982 Application description: PLUMBING Property Zoning: LOW DENSITY .RESIDENTIAL Application valuation: 850 Ta / °F 4 Q" Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: FRANCIS MARK A 79595 MARIGOLD LANE LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/16/11 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 Busines nd Professionals Code, and my License is in full force and effect. Licens lass: C36 license No.: 880103 ate: — I —/ ntractor. — OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_) 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 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.). (_ 1 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.)• Lender's Name: Lender's Address: LQPERMIT ------------------------- - - - - -- ------- - - - - - - WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ I.have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the.Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and.policy number are: - Carrier EXEMPT Policy Number EXEMPT I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I sh Id become subject to the workers' compensation provisions of Section 3700 of the Labor C I s all forthwith comply with those provisions. D t61,plicanr. /WARNING: FAIL RE TO SECURE W RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify'and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit. issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned prop y for inspection purposes. te: — Sig re (Applicant or Agent): Contractor: ALVAREZ, P.O. BOX JORGH 984 A Z THERMAL, (760)777-3613 CA2 - C y / Q Lic. No.. 880 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 Busines nd Professionals Code, and my License is in full force and effect. Licens lass: C36 license No.: 880103 ate: — I —/ ntractor. — OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_) 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 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.). (_ 1 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.)• Lender's Name: Lender's Address: LQPERMIT ------------------------- - - - - -- ------- - - - - - - WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ I.have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the.Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and.policy number are: - Carrier EXEMPT Policy Number EXEMPT I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I sh Id become subject to the workers' compensation provisions of Section 3700 of the Labor C I s all forthwith comply with those provisions. D t61,plicanr. /WARNING: FAIL RE TO SECURE W RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify'and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit. issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned prop y for inspection purposes. te: — Sig re (Applicant or Agent): Application Number . . . . 11-00001240. Permit . . . PLUMBING Additional desc . Permit Fee . . 22.50 Plan Check Fee 5._63 Issue Date . . . . Valuation 0 Expiration Date 5/14/12 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 -------------------------------------------------------------- Special Notes and Comments ---------- INSTALL NEW 40 GALLON GAS WATER HEATER. 2010 CODES. -----------------_---------------------------------------------------------- Other Fees . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due Permit Fee Total 22.50 .00 .00 22.50 Plan Check Total 5.63 .00 .00 5.63 Other Fee Total 1.00 .00 .00 1.00 Grand Total 29.13 .00. .00 29.13 LQPERMIT Prescriptive Certificate of Compliance: Residential CP-1R-ALT-DHW Residential Alterations Page I of 2 Project Name: Climate Zane: P J Permit #: General information - Site Address: '1 Enforcement Agency: Date:. Building T in le Famil ❑ ulti Family. I Project Type lacement or Change Out of Water Heater WATER HEATING List neiviv installed water heaters and boilers for both domestic hot water heaters (DWH) and h ironic space heating. Newly installed DtVH heaters and bdilers un si be gas, propiqrte, or use the eristin me! • e. Water Neater .t Distribution Type Number In (Standard. Tank Energy Factor or External Tank Insulation T Fuel T 1 System YP YPe - Reciavdatin Capacity (gal) Thermal w1c, tency R -Value, 1. Indicate Tvpe (Storage Gas, Heat Pump, lastantaneota. etc.) ' 2. Recirculating systems serving. rnutriple dwelling units shall meet the recirculation requirements of §150(n), The. Prescriptive requirements do not allow the installation of a recirculating tooter heating systein for single dwelling units. J. 71ie external water heating tank and pipes shall be insulated to meet rhe re uirenienti -of § 150U), Contractor or Homeowner (Documentation Author's/Respomlble Building Designer's Declaration Statement) 0 1 certify that this Certificate of Compliance documentation is accurate and complete. • i am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on this Certificate of Compliance. e 1 certify that the energy Features and performance specifications for the building design identified on this Certificate of Compliance conform to the requirements of Title 24. Part t and 6 of the California Code of Regulations. a T1lic building tlesign features identified on this Certificate of Compliance are consistent with the information'provided to document this Lb building design on the -other applicable compliance forms. worksheets, calculations. plans and specifications submitted to the enforceirapplication. Signature: "Mo mje- A 10 -re-?' Company: pate: w ` o _ r License,__ _ Address: 1 —/0-3 CitylState/Zip: Phone: 227 7 Q-777 W QArril 7/1110 storage Water Heater to defined as: 2009 Appliance Efficiency Regulations foe Small Water Heatere, Small Water Heater Is defined as: Type input Gas Stora a 75,000 Btu/hr or less Oil Storage 105,0()o Btu/hr or less Electric Storage 12 kW or less Gas Instant 200,000 Btu/hr or less Oil Instant 210 000 Btu/hr or less Electric Instant 12 kW I or less Heat Pump 24 amps or less storage Water Heater to defined as: Max Btu/hr per Gallon 30 Gallon 1 40 Gallon 50 Gallon 4,000 120,000 160,000 200,000 If rated Energy Factor does not EXCEED minimum Federal Minimum Values Below, an External Insulating Blanket (R-12. Eneray Factor minimum) shall be Installed' Water Heater Fuef Tv Effective Jan 20,2WK 30 Gallon 40 Gallon T 60 Gallon Gas-fired storage -type water 0.62 — (0.0619 x. V) 0.563 0.544 0.525 heaters 0.59 — (0.0019 x V) 0.533 0.514 0.495 01141red water heaters (storage and Instantaneous Electric storage water heaters (excluding tabletop water 0.93 — (0.00132 x V) 0.890.0.877' 0.884 heaters Electric tabletop water 0.93 — (0.00132 x V) 0.890 0.877 0.864 heaters 0.62 — (0.0019 x V) 0.563 0.544 0.525 Gas-fired instantaneous water heaters Electric Instantaneous water heaters (excluding tabletop 0.93 — (0.00132 x V) 0.890 0.877 0.864 water heaters Heat um water heaters 0.93 — 0.00132 x 0.890 0.877 0.864 � I — r..IwA un1 mAs in nallnm 1. Per Section 1500) of the 2008 Energy Efficiency Standards. (&Anril 7-0/0 L �. P.O. BOX 1504 I, No. 082 Building 78-105 CALLE ESTADO '- Address. 79..546 MAricol d La1ad LA QUINTA, CALIFORNIA 92253 �µ " 1 " KINSIS Mailing BUILDING: TYPE CONST. OCC: GRP. Address 23217 Robert Road A.P. Number Cactus Elmer CityZip Tel. Torrance 190505213-316-7067 Legal Description Project Description Patin Contractor PY Address City,. Zip Tela State Lic. City & Classif. Lic. # Sq. Ft. No. No. Dw. Size Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City, Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 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 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 or 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 (8500). ❑ 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 Code: The Contractor's License Law does not apply to an owner of property who Estimated Valuation ��(}(�+) Oar 2 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const.Professions 72 W 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 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.) Plumbing ❑ 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.) ❑ I am exempt under Sec. B. & P.C. for this reason S.M.I. Grading Driveway Enc. Date ­71/1� . �o^yner .� "` e� er 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 ❑ Copy is filed with the city. 0 Certified copy is hereby furnished. TOTAL 7Z.3b CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (8100) valuation or less.) I certify that in the performance of lhg 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. REMARKS - Date Owner NOTICE TO APPLICANT: If, after making this Certificate. or 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 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 Street Setback from Center Line Side Setback from Property Line Lender's Name FINAL DATE Issued by: Validated by: INSPECTOR Date 7�2�9fl Permit Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above-. mentioned property for inspection purposes. Signature of applicant -Date- ateMailing MailingAddress Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SO. FT. ® GAR. SQ. FT. ® CAR P. SQ. FT. WALL SQ. 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, TEM/PERM 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. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL LUMBER GR. SQ.FT.GAR ® V4c HOUSE SEWER FRAMING �Gc 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 ROCKSTORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPIEQUIP. 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 �Gc FINAL INSP. ROOFING �s A/a S 5� fTlpR� / / f n� StiJ S rlf vaJ CSD :� S F /N� 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 Building 7',R-595 •3-595 id Laus ' Address • Owner `Mailing Address 43-,75 Uash3>tptAn St City Zip, La CAli to 92253 Contractor . 'E.G. i22g s Address . • same • 'SMC, - J •I , . ♦ 4 , P.O. BOX 1504 No. 0-588 =Y 78-105 CALLE ESTADO l'. LA QUINTA, CALIFORNIA 92253 ` BUILDING: TYPE. CONST." OCC: GRP. A'.P. Number Tel. �. P3M . , _ . , . • Legal, Description Phase 11 Lot Project Description Plait 3C Cactus Flower Tel.: w_ .State Lic. City & Classif. 49 3919 Lic. #1�3 Sq. Ft. No. No. Dw. • - ` Arch., Engr., Sizes. Stories Units - Designer New Add.❑ - . Alter ❑ Repair ❑..Demolitiori ❑ Address, Tel. .:Cit Y Zip State , Lic. # , LICENSED CONTRACTOR'S DECLARATION . %hhereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section of Division 3 of the Business and Professions Code, and my license is in full force r. and effect. % t SIGNATURE • DATE .. OWNER -BUILDER DECLARATION Estimated Valuation " ••"' 1 hereby affirm that I am exempt from the Contractors License law for the following Y• f) reason: , (Sec. 7031.5,Business and Professions, Code: Any city or county -which requires a "' '; penirif to construct, atter, improve, demolish, or repair any structure, prior to its issuance also - - - , ,:_requires the applicant for such permit. to Ble.a signed statement that he is licensed pursuant to PERMIT i- AMOUNT • . - the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) of. - - ' • ' Division 3 o/ 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 of not more than five hundred dollars (5500). 1, Plan Bal., 480.03 ❑ as owner of the property, or my employees with wages as their sole compensation, will .Chk. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and•- Const.'.. .1 .Professions Code:. The Contractor's License Law does not apply to an owner of property who dohs or improvesthereonand who does himself through his - - '� such work or own employees,% ,;provkfed that such improvements are not intended or offered for sale. it, however, the building Mech. �. .�� .,. •-, or improvement is sold within one year o/ completion, the owner -builder will. have the burden EleCtrlCal � .. - .- +. • .._ -.- - 84.r+ 4 ' .'a: ,. • of proving that he did not build or improve /or the purpose of safe.) .. - . 4• ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- -Plumbing'- y.''. struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner o/ property who buds or improves thereon, and who contracts for S.M.L.- •' such projects with a contractors) licensed pursuant to the Contractor's License Law.) • ❑ I am exempt under Sec.' B. 8 P.C. for this reason Grading Driveway Enc: - ti Dateowner Infrastructure WORKERS` COMPENSATION DECLARATION I hereby affirm that l 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 - ❑ Copy. is filed with the city. ❑ Certified copy is hereby furnished. ' TOTAL CERTIFICATEOFEXEMPTIOWROM WORKERS' COMPENSATION INSURANCE REMARKS- EMARKS - •• ' " _ (this (this section need not. be completed if the permit is for one hundred dollars ($100) valuation .c°�ry4)-I I 7? }'k `J �,, Y -•s `I"`'''g'f f. 'ts i` - t 1•; SY -► - - 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 ' • Owrier • • • - NOT/CE TO APPLICANT: f/„after making this. Certificate o/ Exemption you -should become, ZONE: BY: - subject , to the Workers' Compensation provisions of the Labor Code., you must forthwith - - - - - certrpfywith such provisions orthis permit Shall bedeemedrevoked. Minimum Setback. Distances: Front Setback from'Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY.' 'Side Street Setback from Center Line Ihereby affirm that there is construction lending agency for the performance of •••. _- .,_ 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 E ` 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. , t �1 I certify that I have read this application and state that the above information is correct.. '1 agree to comply with all city and county ordinances and state 'laws relating to building' 'Issued by: DatePermit '- • 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 1 CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ UNITS COLL. AREA SLAB GRADE or ROUGH PLUMB. YARD SPKLR SYSTEM 2ND FL SO. FT. HEATING (ROUGH) STORAGE TANK FOR S MOBILEHOME SVC. BAR SINK FOR. SO. FT. ® DUCT WORK ROCK STORAGE GAR. SO. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) DRAINAGE PIPING CAR P. SO. FT. ® GAS (FINAL) B® TEMP. POLE WALL SO. FT. DRINKING FOUNTAIN. SOFT® WATER HEATER URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM FLOOR DRAIN MECHANICAL FEES GRADING cu. yd. -Plus-x$-=$ WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER ROOFING GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED REMARKS: LAUNDRYTRAY 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 GAR. FIREWALL SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1+/. c SEWAGE DISPOSAL SO.FT.GAR ® 3/<c 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 FEE PLUMB. FEE STRUCTURE PLUMBING s / 40+ELECTRICAL HEATING & AIR COND. SOLAR SETBACK ROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE or ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FOR S SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. G 2, AS (ROUGH)) A LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) B® TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM $ GRADING cu. yd. -Plus-x$-=$ LUMBER GR. FINAL INSP. %��a FRAMING 6 �i FINAL INSP. ROOFING / �Q ,1�P, .2-7-30 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND t7 FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL t