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BLDG (9701-108) + RPL (07564)49220 Marimba Ct 9701-108 07564 LICENSED CONTRACTOR DECLARATION, I hereby affirm under penalty of perjury that I am lice.1G, i LFrrc;e r 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 Date Signature'of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: (}} )' I,`as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business & Professionals Code). ( ) I, as owner of the property,• am exclusively contracting with licensed ' contractors.to construct the project, (Sec..7044, Business & Professionals ` Code). O I am exempt under Section B&P.C.1or this reason VDate r_ ) a, 41-1 Signature of Owner. r+ ,,*:. j d\,,tl , r WORKER'S COMPENSATIO :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 &-'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 become subject to'the ' workers' compensation laws of California, and agree that if, I should become subject to the workers' compensation provisions of Section`of the Labor ode, I shall forthwith complytwith those provisions. ate: t- Applicant 1`?C ,i rKJ Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to/criminal penalties and 'civil fines up to $100,000;.in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT .Application is hereby made to the. Director of Building and Safety for a permit subject to the%conditions and restrictions set forth -on his application. r 1. Each person upon whose behalf -this application is made & each person at . whose request and for whose benefit work is performed under or pursuant to ' any permit issued as a result of this applicaton agrees to, & shall,'indemnify & hold -harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date, of issuance of such "permit; or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to -the building Construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes S gf nature (Owner/Agent) Date L% -- PERMIT # CONTROL # BUILDING PERMIT 4656. DATER ,8 rf ( VALUATION ,'L,i$ .. LOT., TRACTJOB SITE ADDRESS 49-220 NMR) MA IijilitVla. APN OWNER CONTRACTOR / DESIGNER / ENGINEER n(.A. r Irr/ +.jta g, t:,t: su11,1 11 y J )INOWN, USE OF PERMIT ia3 i %/Ai eil 134 b'Uj f@i .;yACTA,' STANf' AR -t t'&T.9WAIA, Sl)P•Lti I y i' . . .t,.I<.i i.Iln a .l. is'O hi.Jl3J `T.t t. .f". ' Si . Yt1` :O .I I` .; 7\. !A'7fivY L .ii•4' : ES'7 r. `%VAIJ, 3 V3.00 .L1' 101-000-418-04V rs x ►.: ,, _.. . s ria ro'1'A , C(,'N. S'd`ddJCflQ'N1 ND f AN ClIECK $72.00 ' .J, 1.E Td: PAID ! SMS $0.00 ` OTAI PERM .0S 9. UE ,- RECEIPT DATE I BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION I DATE I INSPECTOR OPERATION I DATE I 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 POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final 10,Gas Piping PLUMBING ROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances .Final COMMENTS: y 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) To Whoip'It May -Concern: I David Galvin, John Nichols and Jack- Stevens, take -full -responsibility as .Owner/ Builders. for the construct Or 6-Me block wa[lfences on-the Ulowingaddresses: 49-250 Marimba Dr;, I;a Quinta Ca-92253 49-22014lwr m ba Dr 49-190 Marimba Dr. Thank yqp, D- . -'Qrvui Stevens. I P.O. BOX 1504 1.. L3O•6 Building 78-105 CALLE ESTADO Address . 49-220 tati`ir?8 Di"iV£ LA QUINTA„CALIFORNIA 92253 . Owner ,f - QSVd1Yin BUILDING: TYPE CONST OCC; GRP: Mailing Address Sam A.P. Number City. Zip Tel. ti - „ 9' Legal Description TH 21555 Contractor Project Description Trellis ExteartS' em -Address, , City '” Zip Tel.: State Lic:­ . City & Classif. , ' Lic. # Sq. Ft. 312 No. No. Dw. Arch., Engr.; - Size Stories Units Designer, New ❑ Add ❑ ' Alter ❑ Repair ❑ . - Demolition ❑ Address Tel. City. Zip State <. Lic. # >, LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section , t s+ 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'. ^a °.I hereby affirm that I am exempt from the Contractor's License Law for the following Q'3$ reason.-(Sec. 7031.5,Business and Professions Code: Any-city county which requires a W 4 , peir -ao_construdt, alter, improve, demolish, or repair any structure, prior to its Issuance also . - - ,• - .r-.requir'es the. applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT _ 'AMOUNT, .. the pVlsions 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 exempttherefrom, 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 live hundred dollars ($500). - 01 as owner of the property, 9r my employees with wages as their sole compensation, will Plan Chk. Bal. do'llie 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 • 00 -builds 'or improves . proves 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 Mech. or improvement is sold within oneyear of completion, the owner-builder will have the. burden EIQCtrICal ' of provirig, 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- Plumbing.,._ ,=•' ?'' ' 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. - } , ,....• g ., su&h'projects with a contractor(s).licensed pursuant to the Contractor's License Law.) - Grading ❑ rl„am exempt under Sec."-, B. ,B P.C. for this reason Iii.. ftp Driveway Enc. Dated owner Infrastructure a. 1' WORKERS' COMPENSATION DECLARATION 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 O Copy is filed with the city. ' ❑ Certified copy is hereby furnished. TOTAL at 8 CERTIFICATE OF EXEMPTION FROM _ 7WORKERS' COMPENSATION INSURANCE REMARKS`MA9° aioY c 1 (This section need not be completed it the permit is for one hundred dollars ($100) valuation - A q—,+11 or less.) I certify that in the performance of the work for which this permit is issued,'1 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' of Exemption you should become ZONE: ' 'BY: _ subject to the 'Workers' Compensation provisions of the Labor Code, .you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. - 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 Lenders. AddressFINAL DATE'• INSPECTOR " 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. qg L9nq 1 certify that I have read this application and state that the above information is correct.Issued by: Date 5 9G 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 ss .;. . tt ft ..t sr_.. s.a „-> > S 35 S ,cr i rt 1F , '••}t i r nig µr`+c±r* 1`.; ; o[ t T' i. , •-ii" 1iP _. i ¢re'! a s:' `il`, ... ,..L.,,.M .+s; :p'`. .•% J• '' i ., ' : ' Y :Ssv, .:rsr ii;.. '!s_ r.S.> ,.r tS '=-i• rt `•{ ., jc'l 2 ', ' .'a'.. t ' ' , CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. POR. SO. FT. ® GAR. SO. FT. ® CAR P. I 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.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED 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. SO. FT. ® c BATH TUB BOND BEAM SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1+/. c SEWAGE DISPOSAL LUMBER GR. SO.FT.GAR ® 3Lc HOUSE SEWER FRAMING FINAL INSP. GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE EPL.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 © l t 1 * IT 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 Address 494. Address 0 ftMMba Owner David Galvin Mailing. Address. ;49-22.0 Martha City Zip to t3 f lea 922 Contractor Cal Ifo"f a Pools Address P.O. BOX 1504 No., OT564 . • 78-105 CALLE ESTADO LA,QUINTA, CALIFORNIA 92253 r BUILDING: TYPE CONST: OCC: GRP.- A.P.,Number Pare La Quinta J• Tel...,_ 5.%.2759 Legal Description Project Description Pool 4i-410 ${walk SUL A3 City Zip Tel.: - " Pali Desert 92260 „ .Q-3Dt3 State Lic:-.,.'i ` City & Classif: ,--)-; 102 Lic. # ' 355 y Arch., Ehgr.' Designer Address ` Tel. City } Zip State Lic. # ... q.. y • LICENSED CONTRACTOR'S DECLARATION ' I herebyy afti.rm,ih YI am licensed under provisio sof Chapter 9 (commencing with Section' 7000) of Di• ision 3{of the Business and R ofession Code,pand my lic nsis in full force and effect. ' SIGNATURE I— _ s -- DATE '.. OWNER•BUILrDER DECLARATION ' I hereby affirm that I am exempt -from the Contractor's License Law for the following reason: (Sec.._ 703 1. 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`'. th-e applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with -Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis' for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). - . - ❑ 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 land 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.) ,. 0 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 jo ran owner of property who builds or improves thereon, and who contracts for '• such projects with.a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec.• B. & P.C. for this reason - • Date Owner WORKERS'. COMPENSATION DECLARATION" I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company " O Copyis filed with the city. ❑ Certified copy is hereby furnished.:' ` CERTIFICATE OF EXEMPTION FROM WORKERS' COM PENSATIOWINSURANCE ' (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, 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 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 309.7, 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 Sq. Ft. No. Size Siories No. Dw. . Units New ❑ Add p: :Alter ❑ Repair ❑ :-Demolition ❑ .'J, .w j: • ;timated Valuation: $129,0 _ PERMIT 0 AMOUNT ` Plan Chk. Dep. _ " Plan Chk. Bal. • _ , Const. 7 Mech. Electrical MOU , Plumbing S.M:I. • Grading Driveway Enc. Infrastructure FINAL DATEt - INSPECTtORQQ .'J, .w j: • TOTAL 0 .. ' REMARKS i ZONE: BY: Minimum Setback Distances: Front. Setback from Center Line ine Rear Setback from Rear Prop. Line— Side Side Street Setback from Center Line Side Setback from Property Line - FINAL DATEt - INSPECTtORQQ 4l1r` g Issued by: Date . ermit Validated by: Validation: .'J, .w CONSTRUCTION ESTIMATE NO. ELECTRICAL'FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. SO. FT. ® CARP. SQ. 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 WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER ROUGH WIRING ROUGH GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED DUCT WORK LAUNDRYTRAY AIR HANDLING UNIT CFM AS (ROUGH) Xy VVV 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 WATER HEATER SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL BOND BEAM SO.FT.GAR ® 3/ac HOUSE SEWER $ GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK LGROUND PLUMBINGY _ UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING ROUGH DUCT WORK ROCK STORAGE FOUND. REINF. AS (ROUGH) Xy VVV 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. INAL INSP. ~` (/ FRAMING NAL INSP`! —1l ROOFING ( ^ ` REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL + P.O. BOX 1504 N O . '4 5,9 2.0 • Building LA QUINTA CAL FORNIA 92253 ' Address ttg''Z20 igffi fa .• - ,Owner Btircou qev. - ' Mailing - BUILDING: TYPE CONST.... OCC: GRP. - Address" 68-713 Sere$ #1 , ., A.P. Number City Zip Pham 'i1 Lot 3 ' Cat City • 9Z23g ?7 -9024 Legal Description Contractor Project Description- Plan 2222 Etre La € ulnta . Address City' Zip Tel:: • M ..%.l , 4 , State Lic. ' 33)23? Lic. City & Classif. 1 1 ., #. .,• , _ . Sq.„Ft..+2222 No..... ,„ No. Dw Size - Stories Units Arch.,- Engr., ,.Designer-,', ' NewT0 .Add ❑- Alter ❑ - Repair ❑ Demolition ❑ Address-, Tel. r City.Zip State T. Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I amlicensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3o the Business and Professions Code, and my license is in full fo ce and , effect. SIGNATURE - DATE - - ' -” 'OWNER•BUILDER DECLARATION ' •' ' I hereby affirTn that I am exempt from the Contractor's License Law for the following Estimated Valuation. ' 112,161. 00 •• reason: ,(Sec. 7031.5,8usiness and.Professfons 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 pemdt to me a signed statement that he is licensed pursuant to PERMIT` 1 r,•VJ 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 viotafion of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep. subjects the applicant to a cM penalty of not more than five hundred dollars ($500). 'Plan - - Chk. Bal.. '' • tf3 ❑ 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 COrIStti • Professions Code: The CordracWs License Law does not apply to an owner of property who . _ builds or Impves thereon mid who does such work himself or through his own employees, provided that srouch Improvemehis are not Intended or offered for sale. If, however, the building Mech. or improvement is sold within one year of completion, the owner -builder. will have the burden Electrical .4. • 79 of proving that he did not build or improve for the purpose of sale.) - O I, as owner of the property, am exclusively contracting with licensed contractors to con- ' Plumbing I struet the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law - r does not apply to an owner of property .who builds or improves thereon, and who contracts for S.M.I. '- such projects with a contractors) licensed pursuant to the Contractor's License Law.). 0 1 am exempt under Sec B. & P.C. for this reason Grading Driveway Enc: Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm -that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company .0 Copy is filed with the city. 0 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 (5100) or less.)' valuation - - - - 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 Ouv nfrastructure TOTAL 4H2.93 REMARKS A a V n ner , NOTICE TO APPLICANT, If, after 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 Lender's Address This is a building permit when 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 Lhave lead 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 purposesValidated by: ' Signature of applicant Date Mailing Address —Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL SO. FT. ® $ UNITS ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK YARD SPKLR SYSTEM 2ND FL SO. FT. DUCT WORK ROCKSTORAGE ^ FOUND. REINF. , t% vv MOBILEHOME SVC. BAR SINK POR. SO. FT. ® REINF. STEEL GAS (FINAL) TEMP. POLE GAR. SO. FT. ® POWER OUTLET ROOF DRAINS WATER HEATER SERVICE FINAL INSP. DRAINAGE PIPING CAR P. I SO. FT. WATER SYSTEM GRADING cu. yd. $ plus x$ WALL SO. FT. LUMBER GR. DRINKING FOUNTAIN. SO FT ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE Not to be used as property tax valuation 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 SO. FT. ® c WATER HEATER MAX HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® V4c HOUSE SEWER FENCE FINAL 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 %s SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE 7 ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTI TAN ROUGH WIRING. DUCT WORK ROCKSTORAGE ^ FOUND. REINF. , t% vv AS (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 nn % A/ / ' 1 W/V 101g!/ e A REMARKS: VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING p MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESJINITIALS GARDEN WALL FINAL