ELEC (04-7608)a�. Q•
° o
BUILDING & SAFETY DEPARTMENT
c�`4 1t Box 1504(760):777-7012
i
5 CALLE TAMPICO FAX (760) 777-7011
UINTX,_CALIFORNiA 92253 INSPECTION.;REQUESTS (760) 777-.715.3
'r 0 Al ���� " BUILDING PERMIT'
Aication Number 04-0000.7608 Date 12/06/04
Property Address . . 77435—CALLE MONTEREY,
APN: 774-074-026-24 000000 -
Application description ELECTRICAL
Property Zoning COVE RESIDENTIAL
-Application valuation`: .600
Owner Contractor
CALVILLQ RAY'R OWNER
77.435 CALLE ,MONTEREY
LA QUINTA CA192253
Permit' .ELEC-SERVICE CHANGE
Additional desc
Permit Fee 33.50 Plan.Check.Fee .00
Issue Date Valuation 0
Qty. Unit Charge Per Extension.
BASE. FEE -` 1'5.00
1.00 18.5000 EA ELEC SVC <=600V/<=200A 18.50
------------------------------------------------------------------------
Special Notes and Comments
UNDERGROUND INSTALL TO NEW.200 AMP
ELECTRICAL SERVICE
Fee"summary Charged' Paid Credited Due
Permit .Fee Total- ,33`.50 . 00 00 33 50
Plan Check'Total .00 00" :00 .00
'Grand -Total 33.50 00 .00 33.50;:
P.O. BOX 1504 C&f 4 4
"
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number: `f — / 6 9 �f
Applicant:
n
Applicant's Mailing Address:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: /2
Architect or Engineer:
Architect or Engineer's Address:
Lic. No..
BUILDINU PERMIT DECLARATIONS
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 Business and Professionals
Code, and my License is in full force and effect.
License Class License No.
Date Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).):
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 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 or 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.).
U 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.).
U I am exempt under Sec. BA P.C. for this reason
19 ..r — 17 0
WORKERS' 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 Policy Number
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 shall
forthwith comply with those provisions.
=A:pPI,can /C/�-1-1�
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.
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
Lenders Address
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 Ouinta, 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. I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county toe ter upon the above -menti ned property for inspection purposes.
�G ���
i`—Da S atjfre A ant or Agent):
OWNERBUILDER INFORMATION
Dear Property Owner:
An application for a building permit has-been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law- to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits for which they,
apply
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, 'and the work (including materials
and other costs) is $200.00 or more for the entire project, and'such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer and you are subject
to several obligations include' State and Federal income tax withholding, federal social, security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks areespecially seriou's with -
respect to worker's compensation insurance.
For more specific. information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish,, the U.S. Small Business Administration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, .property owners who, are not licensed contracts are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be. contractors; is to secure an "Owner/Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are_ performing' their own work
personally.
Information about licensed contractors may be obtained by contacting .the Contractors' State License Board in your
community or at 1020 N; Street, -Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA. QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253 '
(760)•777-7012
F : (760) 777-7011
c,v2�
OWNER'S GNATURE/DATE
PR0PJtRTY ADDRESS
-- 76R
PERMIT NUMBER(S) -
TAO
:? P.O. BOX 1504 NO,$
Building 78-495 CALLE TAMPICO
Address f 7�41�.: "Calle Monterey:. LA.,QUINTA; CALIFORNIA 92253.
Owner.
ay
BUILDING: TYPE CONST: OCC: GRP.- •-
Maihing
Address - ' S2.' e
A:P.',Num_ber
CityZip
Tel.
L 12]:is3.y ..+�:
�y�5i .....
Legal Description
Contractor
Project Description fide .CJi nen
Address. 0...
'. City :.:'-...
Zip..........
Tel,
State Lic
City
& Classlf
Lic: # - -
Sq. Ft. No -No. Dw.
Size s :Stones - Units - x
-
Designer .
New ❑ Add ❑ ?Alter ❑ c. Repair ❑ ., • Demolition :p
Address
Tel..
" City
Zip _
State`
Lic. #
... LICENSED CONTRACTOR'S DECLARATION
"1
hereby affirm that l am licensed under provisions of Chapter9(commencing with Section '
7b00) of Division 3:of the Business Professions Code,
and and my license is in full force.and
�-SIGNATURE DATE
"
OWNER -BUILDER DECLARATION
I hereby.affirm that from Contractor's License for followin
Estimated Valuation /��g A m
-.liJVV'�:V'
I am exempt the Law the
..-reason:.. (Sec. 7031.5,Bustness and.,. �fessions Code: ,An cit, or coup g
Any . y , 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
1 -
`. PERMIT AMOUNT
the provislons • of the Contractor's License Law, Chapter. '(commencing with Section 7000) of
' Div4sioe_3 0l the. Business and Professions Code, oi- that. he is exempt- therefrom, and the basis
; _. :. � - �. '_ !. t
- _ __... s
for, the alleged.:exemptiar. Any vlolatbn o/ -Section 7031.5.. by 'any applicant 'a- permit
for
.. ..
Plan Chk;. Dep
,�su��b•ects the applicant to a civil penalty of not more-thari five hundred dollars.($500).. -. .•'
`^O
'
Plan.Chk. Bal.
I, as owner of the.property, or, y:employees with wages as. their sole compensation, will..
.
'. °ado the work,'and the structure issnotintended of offered for sale: (Sec.' 7044; Buisness and -
COnSt.
Professions Code: The, Contractor's License Law does not, apply to an, owner ofproperty 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_. „
Mech.
.`�
- . or Improvement: is sold within one year of'completion,-the. owner -builder. will have the burden..-,
_
Electrical., •.; . '. • �-t,' - " ' `
of proving that:he did not build or improve for. the purpose of sale:) . -
, `-t
'O'l, as owner of theproperty,.am exclusively contracting. with licensed contractors to con-
Plumbing 3 �
' struct the project. (Sec. 7044,' Business• and .Professions •Code: ,The• Contractor's License Law
_ .. -
•i.,
does not apply.to,an• bwner,of property who builds or improves thereon,. and.who contracts for
S-M.I. .. - -. -
' -such projects•with' a'contractor(s)Vicensed.pursuant to the Contractor's License Law.) -
Gradin g
❑ -I am exempt under Sec B. S P.0 for this reason -
°
Driveway Eno.
.', . .� C •
ater'e ✓� here-�44,, " "�
Infrastructure
WORKERS' COMPENSATION DECLARATION '
' I hereby affirm that I have 66ertificate'of consent'to self -insure, or a'certificate''of. '
Worker's Compensation Insurance, ora certified copy thereof:,(Sec. 3800, Labor.Code:)
- - - - - •',+
Policy No. Company
❑ Copy"is filed with the city,:. ❑ Certified copy is hereby furnished.
TOTAL-.Qy'0..
CERTIFICATE OF EXEMPTION. FROM.
REMARKS
-• WORKERS' COMPENSATION INSURANCE,' "•
(This need not be completed ff the permit is for•one hundred dollars,
-
orless)section -. ... ,..,._. ..` - ,. ,..
I certify that in the performance of thVjwork for,,wgich'this permit. is issued -I shall not
.. ..
-
-'employ ani person infady'manner saas'.to bedome,sutSject to the Workers" Com pensation
Laws of;California /f ` J��rt�ic7
NOTIQE �Of'APPUCANT.ff -after malung this:, Centric -of Exemption you- should become
-.ZONE' :
ubject .I the Workers Compensadon provisions o/ the Labor Code you•; must forthwith
--^^ r r 1 -
`pMinimum •Setback
comply with such provisions or.this permit shaft be deemed revoked.
Dlstllnces - .
FroritlSetback from Center Line
u % Rear �Setback from.Rear Prop Line
•WARN/NG:FAILURECT JOSECURE WORKERS"COMPENSATION COVERAGEIS.UNLAWF,UL,:AND",
1.41«:•-'ISid�eJSt�eetSetback.frorriCenterLine
L PENALTIES'AND CIVIL FINES UP TO ONE `
EMPLOYER TO .000)''
H
�T
HUNDREDSHALL
THOUSAND DOLLARS ($100NAADDITION O THE OST OF COMPENSAT ON, _
' ' Iry . - Side`efback from Property. Line
DAMAGES AS'PROVIDED FOR IN SECTION. 3706 OF. THE LABOR CODE; INTEREST,: AND
ATTORNEY'S FEES.
FINALjDATE '' - INSPECTOR
T his is a buiidin g permit when properly -filled out, signed and validated; and subject to'
expiration it work thereunder is suspended for 180 days.:
�— K
.I.Certify that I'have.read this. application and state.that the. -above information id correct: •.
ISSued'by: Date- - Permit
l 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. f."
:Vdlldated by: a.
Signature of applicant Date.,—
•
Mailing .. .. ,
,Mailing Address - - � -
..City,
Validation:
State, Zip -
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING. FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. S0. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
-
CAR P. SO. FT.
I
GAS (ROUGH)
DRAINAGE PIPING
WALL SD. 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
i
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
'
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
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
SO.FT.GAR ® VAc
HOUSE SEWER
MESH
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
SEW OR q
ofy
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
I
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
i
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
/& �9 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
s i
t
•
t k
;
- � tr
r
i
-
r,
..
i..
_w`•. v-�._.+a.�+.- _
'.- l�•m'[+�397'R>.'+: }�`6 ,.!.d?'tOG7�e�'.`.rn>,w-�.*�..:nv4wcY�,.�o-.:•xrt7!... _
! Y
.
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-y _.i•o.a?a ,,.orf.:, �r� �.-v.... ys-t+r. r.: Y• ..
'+::a>•.«a.x. -
" '��
.p
COACHELLA VALLEY WATER DISTRICT '
• •
■■
• "
; �'-
CASH RECEIPT DETAIL
Date'
• -' .
f Received From: .:J-
Li
_
C.-..
. - -
Address:
I
Lots)
Account No.
DA. Code
_
+ Service Address 4C-
_
t
f O Meter(s)
+
0 Services)
'
❑ Backflovdsl
•,
•
t (3House Lateral(s)
❑ Detector Checks)-
'
❑ Meter Surcharge-
'
%- Sanitetion Capacity Charge
..
❑ W.S.B.F.C.
"- -
O Temporary Construction Meter
..
0 Turn on Charge-
•
+ 0 Uncollected Account - Name
;
❑ tnspeotion Fee - Tract -
Fee
.
'
•1 ❑ Pian Check Fees Water I Sewer -
_ _
~
r
• " , "
Tract-
.,
.
O Bond fayment - A.D. -_Bond
.
❑ Customer Deposit
❑ Other
$
TOTAL
C
•' •
Remarks:
, I
-
OCo
')t to:
py
t
Water Service
Cashier
~ ,
•
,
r i
r
v
4-4
SANCO---
PUMPING 'SERVICE ( ,
-p
2502 Morongo Trail
Palm Springs, CA 92264
(619)327=8859 -
N2 .17421
SO)a TO
SHIPPED TO
§TREE NO. STATE. STREET NO.
CITY STATE Zpb CITY STA TE' z If
. ,fir•
City
City"
Lic. # • - - •<
Sq. Ft:.
Building
Address
77-435
Mont
Owner
Stories Units
Arch:, Engr.; -.. _
..:Designer _
New E Add E
Alter E. Repair O Demolition E'
Mailing
Tel.
Address
same
City
Zip
State
Zip
Lic.
Vy
Contractor
hereby affirm that I am licensed under provisions of Chapter (commencing with Sections
7000) of Division 3 of the Business and Professions Code; and my license is in'fulf force and
effect.. ' / / Grp
SIGNATURE- i > "' '" DATE
Address
..
78-550
Darb
City
PERMIT
-
- AMOUNT '
the provisfonsof 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 therafrom, 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): ..
- 0 I, as owner of the property; or my employees with wages as their sole compensation„will
4
P.O. BOX 1504 No... 003853
78-105 CALLE ESTADO
r LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST: OCC: GRP.
A..P. Number 774-074-001
el.
Legal Description
2;73
Project Description Re -roof C1Ltest house
tz f'c�
Road
Tel...
State Lic.
& Classif..
City
City"
Lic. # • - - •<
Sq. Ft:.
No. No. Dw.
Size
Stories Units
Arch:, Engr.; -.. _
..:Designer _
New E Add E
Alter E. Repair O Demolition E'
Address
Tel.
City
Zip
State
Lic.
Vy
LICENSED CONTRACTOR'S DECLARATION
hereby affirm that I am licensed under provisions of Chapter (commencing with Sections
7000) of Division 3 of the Business and Professions Code; and my license is in'fulf force and
effect.. ' / / Grp
SIGNATURE- i > "' '" DATE
' OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Seca 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 signedstatement that he is licensed. pursuant to
Estimated Valuation,
®g Fa
$8 00
PERMIT
-
- AMOUNT '
the provisfonsof 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 therafrom, 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): ..
- 0 I, as owner of the property; or my employees with wages as their sole compensation„will
-
Plan Chk.. Dep..
'
Plan. Chk. Bala
-
pp ��qq
S20 e,i 0 .
do the work, and the structure is not intended or•offered for. sale: (Sec. 7044, Buisness and.�qq.y�y
.. 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.
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 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. t. P.C. for this reason -
S. M. 1.
-
Grading
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
' 'I hereby affirm that-[ have a certificate of consent' to'self-insure,'or a certificate of
. Worker's Compensation Insurance, or a certified copy thereof.(Sec..3800, LaborCode.)
Policy No. '-I s stFw Company�°ir 3'•� '..4e _/.
+Copy s,filed with the city. .O Certifiedreopy is hereby furnished.
TOTAL
�7+
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION. INSURANCE
REMARKS
4lft,',�`�" ”' W' �'8— firs'
` T
a �.
(This section need not be completed if the permit is for one hundred dollars (3100) valuation
or less.) ... .. _ - .. ..
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.
-
' Dale ' Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you. should become
• 'subject to the Workers" Compensation provisions or 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 -
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
-. 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 I have read this application and state that the above information is correct.
I agree'to comply with all-bity'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. 7Validated
Issued by:
y
by:
Date ! F� �f1F Permit
Signature of applicant Date
.Mailing Address
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT. (i;1
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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL, FLOOR SUSPENDED
OTHER APP./EQUIP.
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)-
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER Ga.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATICN
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
I NSU LATI ONISOU N D
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
1 VM'J WUNAI UKLWIN1I IALS,
GARDEN WALL FINAL