Loading...
PLBG (0210-145)LICENSED CONTRACTOR DECLARATION 1,r.ereby affirm under penalty of perjury that I am licensed under provisions of 'chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License s# 5.5 15 n^Licf. Class Exp. Date M rpr 475.515 S'A, S3.6`•hiC 4 t1 7� Ai�1 6L Date �u �� �' Signature of Contract�oi` 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). ( ) 1, 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. ( ) 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 STATE rUND Policy No. 044-02-ON97YO (This section need not be completed if the permit valuation is for $100.00 or less). (i) 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 Code, I sha(I forthwith comply with,those provisions. Date:/,; 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, y application. w . 1. Each person upon whose behalf this application is made & each• person at r 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 forr inspection purposes. Signature (Owner/Agerit)�- �-" -�- Date!'Q/' BUILDING PERMIT PERMIT# 02I.M.145 DATE 1 %/ VALUATIONS LOT TRACT JOB SITE ADDRESS s� bl"fa� A A +iF ifJC�A? APN '773-W2,018 OWNER CONTRACTOR / DESIGNER / EN INFER 'MO. YCi3...EOMA M,=I TRY STAR C0ERSii<:UC110M 52.641 AVE, MWDOZA 34 ? 30)),X.x. PAT M'11A DM't R LA QUIW:'>a CA 92253 CA71-TU URAL CITY CIA. 92235 ' (76o)321.0ags IX- 762 USE OF PERMIT Ta:E,�31�i3i�t'C • SEPTIC AB.UQX)N SKWr1 :, HOOK-UP (LOW -MOV PRO.tWT 200"2) V ALUA.z IUN 1,fi DA D Ix pAJ,Aii"dJ1D COST F 5.ailTISI .i.F.WarION .31M.00 X ha"v MUMBINC ITFl . 10') -WO -41 9-000 W1.00 w A.(r C'C'd1;3•-TOTAL CrO4Ti'IriXTCr10 AM) TAT !l CF.::ROCO. Y(YCAY. PERM In= DU 11 OW OCT 2 2002 WYOf ILAQUINTA FINANCE DEPT C RECEIPT DATE +, By rf E IN F,B, n DAjl/ q/ (� INSPIC t .cis IC/.� V INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE 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 BLOCKWALL APPROVALS POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground PI . 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 �� 7L� Gas Piping Encapsulation Gas Test Appliances Final 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) COMMENTS: r✓ HAMMER PUMPING INC. JOB INVOICE P.O. Box 2448 CATHEDRAL CITY, CALIFORNIA 92235-2448 i7sni asn-AAAA NON 321- 7448 CUSTOMER'S ORDER NO. DATE ORDE ED // >/��•z ORDER TAKEN BY DATE PROMISED 0 A.M. 0 P.M. BILL TO PHONE ADDRESS MECHANIC. S CITY HELPER 'JOB NAME AND LOCATION ^ 1 � ` - ,r"- /vjt. 4c -,r „�n 0 DAY WORK OF WORK 7t- / ❑CONTRACTDESCRIPTION 0 EXTRA %C ©C r QUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT Gallons Pumping Fee per 1000 gal. ?Q©C, Dumping Fee' per 1000 gal /06 Out of Area Fee Locating / Opening Fee (per hour) Size System: t A SERVICE CHARGE OF $20 WILL BE DUE ON ALL RETURNED CHECKS. 18% PER YEAR WILL BE CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS. HOURS LABOR AMOUNT TOTAL MATERIALS MECHANICS @ HELPERS @ TOTAL .LABOR I hereby acknowledge the sat�'sfactory TOTAL LABOR completion•of-t}ielabove described work: TAX SIGNATURE' �� DATE COMPLETED TOTAL, P.O. BOX 1504 Building 78-495 CALLE TAMPICO Aedress 52-641 , Avenida Mendoza LA QUINTA, CALIFORNIA 92253 Owner maning Address Sam City Zip La Quinti 92253 564-3734 Contractor owner/builder Address Tel.: State Lic.I City & Classif. Lic. # • Arch., Engr.' Designer Address Tel. , City (Zip (State r 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. TtGNATURE 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, 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 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 penally 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 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 ownemployees, 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 knprove for the purpose of sale.) O I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business andProfessions 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 WORKERS' COMPENSATION DECLARATION 1 hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ 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 ff 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 become subject to the Workers' Compensation Laws of California- Date-Owner aliforniaDateOwner NOTICE TO. 'APPLICANT.- ff, after making this Certificate of Exemption your should become subject to the Workers' Cornpensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR .IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. This is a building permit when properly filled out, signed and:validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to.building construction, and hereby authorize representatives .of this city to enter the above-. mentioned property for Inspection purposes. Signature of applicant Date Mailing.Address City, State, Zip No. 148.8 WING: TYPE CONST: OCC: GRP. P. Number Description roject Description 240 Sq f$ Patio Cover Sq. Ft. No. No. Dw. Size 240 Stories Units New ❑ Add ❑ Alter ❑. Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT. Plan Chk. Dep. Plan Chk. Bal. 40.95 Const. 63.00 Mech. Electrical Plumbing S.M.I. .32 Grading Driveway Enc. Infrastructure TOTAL 104.27 REMARKS 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. e FINAL DATE INSPECTOR t J Issued by: Date Permit _ Validated by: Validation: MAK U 2 1995 a, ' By CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING F 1ST FL. SO. FT. ® $ UNITS `T. 2ND FL. SO. FT. BONDING YARD SPKLR SYSTEM POR. SO. FT. MOBILEHOME SVC. BAR SINK i GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CARP. SO. FT. GAS (ROUGH) DRAINAGE PIPING WALL SO. FT. OTHER APPJEOUIP. DRINKING FOUNTAIN, SO. FT. ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. 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, TEM/PERM 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 GAR. FIREWALL SO.FT.GAR ® 3/ic HOUSE SEWER LATHING 3 ` GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PPL.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 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 3 /0 9� FINAL INSP. ROOFING � REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING 3 ` MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/1NITIALS GARDEN WALL FINAL o � m � C Q� o � m � C U) in rn r cn 9 o CID A 78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (760) 777-7000 FAX (760) 777-7101 TDD (760) 777-1227 December 19, 1997 John Perez 52-641 Avenida Mendoza La Quinta, CA., 92253 RE: Patio Permit #14816 & Kitchen Addition/Patio Permit #13245 Dear Mr. Perez The purpose of this letter is to inform you that your Building Nrmits #13245 & #14816, for the project at 52-641 Avenida Mendoza, has expired. In accordance with 1994 UBC section 106.4.4, no further work may be performed until a new permit has been issued. Please contact Daniel P. Crawford Jr., Building Inspector I, at (760) 777-7012 to obtain any. information you need regarding a new permit and/or any required inspections. Should you choose not to complete the project, we would then have to pursue any or all of the following actions: 1) Abatement of the project through the -City Attorney's Office and Code Compliance Division. 2) Notice of non -conforming structure placed upon property profile. 3) Action filed with Contractor State License Board. Optional if OwnerBuilder. Please contact us at your earliest convenience prior to 10 working days to resolve this issue, and for any questions you may have. Sincerely, Mark Harold Buildi & Safety Manager Daniel P. Crawfor Jr. Building Inspector I cc: file dpc MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253 ` t. r GV • P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 52--641 Mendoza LA QUINTA, CALIFORNIA 92253 Owner John Perez Mailing Address Same Cit Zip Tel. fa Qui.nta, Cly 92253 564-3734 Contractor Owner/Builder Address City lZip Tela State Lic. I City & Classif. Lic. # Arch., Engr., Designer Address Tel. CityI Zip I 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. r 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 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 sub acts the applicant to a civil penalty of not more than five hundred dollars ($500). 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.) O 1 am exempt under Sec. B. & P.C. for this reason Jets t 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 ❑ 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 ($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. 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 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 ateMailing Address City, State, Zip BUILDING: TYPE CONST A.P. Number Q.,\ , --" .-I— ��_ No. 13245 OCC. GRP. Legal Description Project Description 165 sf. Kitchen addition 264 af. patio ?Lover Sq. Ft. , Size am.. -m=. New ❑ Add ❑ Alter ❑ Repair O Demolition ❑ No. __too. Dw. - Stories _Units_, t Estimated -Valuation $12,141.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 93.60 Const. 244.00 Mech. 15.00 Electrical 20.78 Plumbing .00 S.M.I. 1.30 Grading Driveway Enc. Infrastructure TOTAL d I4. viii REMARKS 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. SQ. FT. @ $ UNITS COLL. AREA SLAB GRADE (/1n ROUGH PLUMB. YARD SPKLR SYSTEM - ' 2ND FL. SQ. FT. ® HEATING (ROUGH) STORAGE TANK FORMS / MOBILEHOME SVC. BAR SINK POR. SO. FT. @ DUCT WORK ROCK STORAGE GAR. SO. FT. @ POWER OUTLET ROOF DRAINS CAR P. SO. FT. @ HEATING (FINAL) DRAINAGE PIPING WALL SO. FT. GAS (FINAL) DRINKING FOUNTAIN SQ FT @ URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER HEATER WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FINAL INSP. LAUNDRY TRAY AIR HANDLING UNIT CFM ��� _t� 3 �,V I' 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 SQ. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID @ 11/4 c SEWAGE DISPOSAL GAR. FIREWALL/2_/3-93 ZV SQ.FT.GAR @ 3/4c HOUSE SEWER LATHING 2--! 3 — /3 40 GAS PIPING PERMIT FEE MESH 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 (/1n 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 O_G(1 � � !J ��� _t� 3 �,V I' fo REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL/2_/3-93 ZV LATHING 2--! 3 — /3 40 MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL 4 4 " P.O. BOX 1504 No. 10823 Building 78-105 52-641 Mendoza LA QUINTAC Address CALIFORNIA 92253 oJuaaz C. Perez BUILDING: TYPE CONST. OCC: GRP. Mailing Address same A.P. Number Legal Description Project Description 1301 of 6' block wall; 35' of 5' 35' City La Quanta Zip 92253 Tel. 664-3734 Contractor Owner/Builder Address V block wall City Zip Tel.: -of State Lic. City & Classif. Lic. # Sq. Ft. Size No. No. Dw. Stories Units Arch., Engr., New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Designer 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 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, after, 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 sybjects the applicant to a civil penalty of not more than rive hundred dollars ($500). Q1, as owner of the property, or my employees with wages as their sole compensation, will Estimated Valuation , 6� PERMIT AMOUNT Plan Chk. Dep. . Plan Chk. Bal. t. COr1S72.00 rind 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.) Mech. Electrical Plumbing ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Strutt the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law S.M.I. .50 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.) ❑ I am exempt under Sec. B: & P.C. for this reason Grading Driveway Enc. Date ~� '�fOwner i a,' {� i x 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•yy ❑ Copy Is filed with. the city. ❑ Certified copy is hereby furnished. ((yyr TOTAL _7 2, 5.0 . CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS (This section need not be completed If the permit is for one hundred dollars ($100) valuaffon 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. % y Date�C NOTICE TO APPLICANT: ' er 'making this Certificate of Exemption • you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthikh 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.) Lender's Name FINAL DATE Side Street Setback from Center Line Side Setback from Property Line INSPECTOR 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. Issued by: Validated by: Date Permit Signature of applicant Date Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. @ $ 2ND FL. SO. FT. FOR. 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,TEM/PERM 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 ® 1 Va c SEWAGE DISPOSAL SO.FT.GAR ® 3y<c HOUSE SEWER REMARKS: GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PLCK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE ! 6 PLUMBING ELECTRICAL HEATING a AIR COND. SOLAR SETBACK OZ GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE IAI I 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 2( 2_c, 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/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL