04073 (SATT)' u
P.O. BOX 1504
Building 80-659 Cherry v lLA O
Address UINTA, CALIFORNIA 92253
ftinvi de Company
Mailing
Address 75-005 CfltAi"E'IL: 71 Club. LD, ri'F➢E°e
City Zip Tel.
Palm Desiirt 92260 1 563-2323
Contractor
B'Classif. 228130 ILicy# 328
Arch., Engr.,
Address
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that.l'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. _
S16NATt1RE - DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 703L5,Business and Professions Code: Any ortY or county which requires a.
perms to construct, alter, improve, demolish, or repair any structure, prior to ea Issuance also
niWires the applicant for such perms to No a sIpned statement that he k ficenaad purouard to
the provisions of the Contractor's License Law„ Clupter 9 (eonxnenehrg wsh Sector 7000) of
Division '3 o/ the Business and Professions lode; or, that, he Is exempt therefrom, and the basis
for the eseped exemption. Any vblatlon of Becton 7031.5 by 'any app5cant lora Perot
subjects Me applk;arit to a cMl penesy of not more than Ave hundred dollars (S500).
O 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, Bubmass and
Professions Code: The Contractor's License Lew does not apply to an owner of property who
builds or Improves thereon and who does such 'work himself or through his own employees,
providedthat such Improvements are not ,intanded or offered for sale. t, however, the building
or hnprovement 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 ofthe,property, am exclusively contracting with licensed contractors to coo-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License. Law
does not apply to an owner of property who bunds or Improve$ thereon, and who contracts for
such projects with a contractor(s) licensed, pursuant to the Contractor's License Law.)
❑ 1 a exempt under Sec. -B. 8 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 certified copy'lheroof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATEOF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed If tie perms Is for one hundred dollars (1100) valuator
or less.)
1 certify ptthat In the performance of the work for which this, permit is Issued, I shall not
Laws of Oallfarrlian in any manner so as to become subject to the Workers' Compensation
Date Owner
NOTICE TO APPLICANT: s, after making this, CerfMbete of Exemption you should become
subject to the Workers' Compansedw provisions of the Labor Code, you must forthwith
comp,y with such proviskms or.fhis permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work forwhlch this permit is Issued. (Sec. 9097; CMI Code.)
Lender's Nama
Lender's. Address
This Is a;bullding perrnit when properly filled out, signed and valldated,.and is subject to
expiration it worK.thereunder 1s suspended for 180 days.
I certify that I have read this application and state that.the,above inform rtlon le 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 purpose&
Signature of applicant Date
Malling' Address
City, State, Zip
WHITE =.FINANCE, PINK -APPLICANT. GREEN - BUILI
l :u;
TYPE CONST.' OCC. GRP,
Number TIGA V63t
Description
:t Description Phase 113, Plan 40M3
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 4NSPEOTR
Issued by: Date Permit
Validated by:
Validation:
-,ASSESSOR'S OFFICE, HARD COPY -FILE
-moi
Sq. Ft. 3142
Size
No.
Stories
No. Dw.
Units
New ❑ Add O
Alter ❑
Repair ❑
Demolition ❑
Estimated Valuation
v $
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
—3.
Const.
2 . i m
Mech.
Electrical
12U .615
Plumbing
--T-60
. 55 0
S.M.I.
Grading
Driveway Enc.
Infrastructure
'S 0
5 55 o
TOTAL
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 4NSPEOTR
Issued by: Date Permit
Validated by:
Validation:
-,ASSESSOR'S OFFICE, HARD COPY -FILE
-moi
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL • SO FT 4r S
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. C
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING -
MOBILEHOME SVC.
,BAR SINK
POR SO FTR
GAS (ROUGH)
METER LOOP
GAR SO. FT. Q
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CARP Sao FT M
GROUT
WATER HEATER
WALL SO. FT. f
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SO, FT. M
=S
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION t
FINAL INSP.
WATER PIPING
NOTE: Not to be used es property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTONDISH)
APPLIANCE' DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
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 g 1 % c
SEWAGE DISPOSAL
SO.FT.GAR a
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECK E L.CK.FEE
CONST., FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 6 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.JEOUIP.
REINF.,STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu.yd.
= -plus-4
=S
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR'
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
I ECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
,
GARDEN WALL FINAL 71
CITY OF LA OU 1 NTA
w' DEPARTMENT OF PLANNING & DEVELOPMENT
BUILDING DIVISION
564-2246
24-HOURNOTICE FOR INSPECTIONS
Owner Sunrise Company
Contractor National Mortgage
Permit Number 4073
P03T ON Joe IN co"MCUM PLAit'E
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOBADDRESS__ 80-659 Cherry Hills
"Single Family Dwelling"
TYPE OF INSPECTION I DATE INSP.
FOOTING STEEL I (�, - (S :5, Y I /,e--
GROUND
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
NI
DO NOT POURtONCRETE UNTILABOVE HAS BEEN SIGNED
ROUGH GAS & GAS TEST j ( �
HEATING & VENT- A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WnAP /0 7 i
COVER NO WORK UNTIL ABOVE HAS:BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH a%
POOL FENCE & GATE
SEWER SEPTIC TANK T
FINALS
ELECTRICAL 01
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING