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PLBG (0011-296) + BLCK (9571)53360 Avenida Martinez 0011-296 9571 LICENSED CONTRACTOR 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. Licens4ff - I Lic. Class Exp. Date at5153 C42 MIC 02/2W(.Defe ! - < 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). ( ) I am exempt under Section B&P.C. for this reason Date Signature of Owner 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. ()e 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: Carver Policy No. VMS iTrP1) 1SIMZI-04 (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 3700 of the Labor Codj",Kshall forthwith comply with those provisions. Qa>e: - l.ax.2 Applicant, rr a .iii "-ti+ w ..— 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. 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. r d 4 -nature (Owner/Agent) a -+A- ^' Date J# ? —0 411/ v -- _- BUILDING PERMIT PERMIT# DATE VALUATION LOT 0011- TRACT 12131/2AC SIAM190 JOB SITE APN ADDRESS 53,W, AVE MAKiWit - OWNER CONTRACTOR/DESIGNER/ENGINEER suaAii S IAR17., EC014011 k'WER Si'F1VICE 53.445 AVE `lEi.F M 84035 CABAZON RD. INDIO, C,'A 92201 LA Qtlii+l'rA CA 92253 PALM UL T CA 32261 (760)346.2793 MIA 342 USE OF PERMIT PL U)&gNG SEPTIC AY1JkWD014MVNT -SEWER HOOK-UP V.A1,U,AT1p'f4 11300.00 W RS]IWl"3 C'OS'T' OF Ck"INIMMMON "'W'W FXtiiMT 111KE SUMMARY PLUMB NO FEE 103.000-413.000 530.00 SUB -TOTAL O NS NUC'I ON AND "A CITECK LFM PRR-PAM F.CW wf3.0U RECEIPT DAT i /- / f I BY / iJ DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set hacks Underground Ducts Forms & Footings Ducts SlahiGrade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS 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 —GY% $ Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) / e ELECTRICAL 34PPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Vottage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: -5 COACHELLA VALLEY WATER DISTRICT )" CASH RECEIPT DETAIL ` Received From: Addrr ss: f .? ^, 1 `L (:i°7 . / ii /O 'r L 6,0 . Acc unt No. Lotjs) _ Tract- ract f -5 Service Address a vjg ❑ Meter(s) %i ❑ Service(s) ❑ Backflow(s) t ❑ House Lateral(s) ❑ DetectorCheck(s) ): ❑ Meter Surcharge ' ❑-4Sanitation Capacity Charge ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - ; Fee - ' • ❑ Plan Check Fees Water I Sewer - l: Tract - ❑ Bond Payment - A.D. - Bond r1 Assmt. b t ❑ Customer Deposit :i ❑ Other X G.A. Code I r 7 sem. s _Date: TOTAL $ C\ Remarks: uppy to: Cash Water Service Check Money `,; :. Order Cashier J. CVWD-438 (11189) 4 S:' •.l;.. b.: r.+t .i: 1. ..1. Hb M1'+•Nn': ;. J;:"n t•:>.. rt - s ..• v • V P.O. BOX 1504 No. Address 53-360 AYanidB M i" LA QUINOTACCALIFORNIA92253 Address , Owner mailing Address City Zip Tel. La OL 92253 55 4924 Contractor Aaaress abom I... I State Lic. City & Classif. Lic. # Arch.,'Engr., Designer Address Tel. BUILDING: TYPE CONST. - OCC: GRP. 1 A.P. Number 7e 7 Legal Description C3 Project Description Sq. Ft. n2 MM ft No. No. Dw. Size •Stories Units New ESC Add ❑ Alter ❑ Repair ❑ Demolition ❑ City Zip State Lic. # 5 ft: high '91iwd feWe• LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisionsof 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?S- reason: (Sec. .703 1.5, Business• 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 requires the applicant for, such permit to file a signed statement that he,is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or thathe 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 rive 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 Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building . or improvement is sold within one year of completion, the owner -builder will have the burden . of proving that he did not build or improve for the purpose of sale.) ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law • does not apply to an owner of property who builds or improves thereon, and who' contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - D I am exempt under Sec. B. & P.C. for this reason f^t Estimated Valuation h PERMIT -AMOUNT t Plan Chk. Dep. . Plan Chk. Bal. i 7.2, 2 Const. Mech. Electrical - Plumbing S.M:I. a5 Grading Driveway Enc. Date % ' owner x i -- . - *-r • Infrastructure WORKERS' COMPENSATION DECLARATION Ihereby 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. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (8100) valuation or less.) - 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 TOTAL 44.2 REMARKS 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. 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 1 have read this application and stale 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 insfpection,purposes. / Signature of applicant .•` Date Mailing Address ' r _ City, State, Zip J G' HARD COPY ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: A 1 4 6 9 6 6 44.22 CK CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. POR. SO. FT. ® GAR. SO. FT. ® CAR P. SO. FT. WALL SO. FT. ® SO FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) 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,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 ® 1114 c SEWAGE DISPOSAL SO.FT.GAR ® 3/4c HOUSE SEWER REMARKS: GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE ME:H.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 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOU N D FINISH GRADING FINAL INSPECTION CERT. OCC. / 't /!FENCE FINAL VVV INSPECTOR'S SIGNATURES/INITIALS, GARDEN WALL FINAL r A' 4 P.O. BOX 1504 N o . Address Building53-360 Martinez LA QUINTACCALIFORNIA92253 Addres Owner Jon Dmins Mailing BUILDING: TYPE CONST. OCC: GRP.; Address Same A.P. Number City Zip Tel. La Quinta 9-253 554-1439 Contractor I Dwner/Builder City jZip j Tel.: State Lic.I City & Classif. Lic. # Arch., Engr., Designer Address-T—Tel. CityI Zip I State I 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,Susiness and Professions Code: Any city or county which requires a permit to construct, aller, 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) 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 rive hundred dollars (5500). WI, 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 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 f WORKERS' COMPENSATION DECLARATION t 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. O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to becomd'subject to the Workers' Compensation Laws of California. ` n t Date Owner Y L .yF NOTICE TO APPLICANT: eller 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 if work thereunder is suspended for 180 days. I certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter the above-. mentioned property for Inspection purposes. Signature of applicant Date Mailing Address City, State, Zip 9571 Legal Description Project Description Brick fence in front' yard 98 if at 41 high Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation '1795 00 PERMIT AMOUNT Plan Chk. 'Dep:' ' Plan Chk. Bal. Const. 45.00 Mech. Electrical Plumbing .20 S.M.I. Grading Driveway Enc. Infrastructure TOTAL 45.20 REMARKS 16 0911 _ TE.i'rAL 1 45.20 ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE' NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. 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 SLAB GRADE FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER ROUGH WIRING. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED DUCT WORK LAUNDRYTRAY AIR HANDLING UNIT CFM GAS (ROUGH) 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 WATER HEATER SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1% c SEWAGE DISPOSAL BOND BEAM SO.FT.GAR ® 3Y.c HOUSE SEWER $ GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE M=CH.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 f ���� 9i /%` '►/ 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 4 CQ P.O. BOX 1504 No. 002802 Building78-105 53„360 L d Z LA QUINTAC Address CALIFORNIA 92253 Owner Mailing BUILDING: TYPE CONST. OCC. GRP.' Address A.P. Number_ City Zip Tel. La. Quince 92253 %4-1439 Legal Description Project Description _ Contractor tit %3aldiax .Address. 88i'ifr' City Zip Tela ' State Lic. City & Classif. Lic. # Sq. Ft. No. No. Dw. Size 120. lin Stories Units Arch., Engr. , - ' Designer New 02 Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State 6—fWdt1k chadn U& f/:we to r)8w Lic. # vellatAtim p Ibed at tim of final 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 Contractors 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) 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), ' - 0 I, is owner of the property, or my employees with wages as their sole compensation, will, Estimated Valuation 480 0 p / ry t VatriT - PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. 20.00 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 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 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.). Electrical' ' 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 root apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) O I am exempt under Sec. B. & P.C. for this reason r S. M. 1. ( Grading Driveway Enc. r j Date f y- /Owner\) r t e' I f - Or "e" 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 ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL 20550 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS (This section need not be completed if the permit is for one hundred dollars (5100) valuation or less.) I certify that in the performance of th0 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' Corrpensation 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 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. 12 "permit I certify that I have read this application and slate that the above information is correct. Issued by: Date I agree to comply with all city and county ordinances and stale laws relating to building construction, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposass t / r /1 Validated by: Signature of applic nt• f % f r - I el r l! ODate Mailing Address J* f x '^' % (' Validation: City, State, Zip A 7 0 0 0 11 30 2 L R HARD COPY iNN CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ UNITS COLL. AREA 2ND FL SQ. FT. ROUGH PLUMB. YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. I SQ. FT. DUCT WORK DRAINAGE PIPING WALL SQ. FT. GAS (ROUGH) DRINKING FOUNTAIN SQ FT ® HEATING (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ GAS (FINAL) WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER HEATER WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER WATER SYSTEM GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GRADING cu. yd. $ plus x$ LAUNDRY TRAY AIR HANDLING UNIT CFM 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. SQ. FT. RESID @ 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL IL 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 APP.IEOUIP. 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 DEC 17 199K 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