15747 (BLDG)P.O. BOX 1504 No. 1 5 T 4 t
Building78-495 '77-511 Calle Arroba LA QU NTAC
Address CALIFORNIA 92253
Owner Walter & Cathterine Hunter
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address . ' 77-511 Call: Arroba
A.P. Number
City - Zipr Tel _
a�Z53 771-1360 Legal Description"
Contractor 'Owner BuilderProject Description '.Re -Stucco house/Install
AddressSwamp Cooler
Satfto ' a s above
City Zip Tel.:
State Lic'. I City
& Classif. , Lic. #
Arcn., tngr., I
Designer..
Address • Tel.
City: Zip State
Lic. #
I.. 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 affign-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 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or mproves thereon and who does such work himself or through his own employees,
provided Nat Such improvements are not Intended or offered for sale. If, 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 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 propertywhobuilds or improves thereon, and who contracts for
such projects with'a crintractor(s) licensed pursuant to the Contractor's License Law.)
a ❑ 1 am.eicempt under Sec B. & P.C. for this reason
i
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. ❑ Certified copy is hereby furnished.
-CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section, need 'not be completed U the permit is for one hundred dollars 1$100). valuation
orless.) - -
I certify that in the performance of thg 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: N, -alter 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. '
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 THELABORCODE, INTEREST, AND
ATTORNEY'S FEES.
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 car tity 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. - '.y
Size
No. No. Dw. .
Stories Units
New ❑ ." Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation '.
$1,000.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. '
Const...
l5. lfiU
Mech.
1.50
Electrical
$ • t3Q
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTALb
REMARKS
ZONE: __-BY:
Minimum Setback Distances
Front Setba
Rear Se frorr
Side Str t Setbq
Side Setck from
FINAL DATE
Issued by: Date
Validated by:
ne
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR, SQ. FT. @
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT. ®
GROUT
WATER HEATER
WALL SQ. FT. ®
FINAL ILISP.
DRINKING FOUNTAIN
SQ. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
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
FIRE ZONE ROOFING
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
LATHING
MESH
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+A c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
'
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 V"ORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATIN;, (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL ILISP.
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/SOUND
FINISH GRADING
FINAL INSPECTION l�F/
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL