10422 (BLCK)P.O. BOX 1504
Buildin78-105ALLE
Addrress 46--855 Highland Palms LA QUINTACCAL FORNpIA 92253
Owner H. V. it dkerson.
Address SaMe
City Zip Tel.
a Quinti 92^53
Contractor
Owner/Builder
Address. .
Zip I Tel.:
State Lie. City
& Classif. Lie. #
Arch., Engr.,
Designer
BUILDING: TYPE CONST
A.P. Number
r
No. 10422
OCC: GRP.
Legal Description
Project Description
x 901 of 61, good Pence
Sq. Ft.
Size
No.
No. Dw
Units
New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑.
Address
Tel.
City
Zip
State
Lie. #
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
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
A
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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 •
_ PERMIT
AMOUNT
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
Plan Chk. Dep.
sOects'the applicant to a civil penalty of not more than five'hundred dollars ($500). p
'
Plan Chk. Bal.
5 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
Const.
25.00
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,
Mech.
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
Electrical
of proving that he did not build or improve for the purpose of sale.) -
O 1, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
,
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
S.M.I,
10
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) _
Grading
❑ I am exempt under Sec. B. 8 P.C.•for this reason =
r
Driveway Enc.
Date Owners - r` r' j�--=...- �---r ---- -
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a.ceitificate of
Worker's. Compensation Insurance, or a certified copy 3hereof..(Sec.,3800,. Labor Code.)..
,
'
Policy No. company
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL:)
• laI
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it 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 i' • r , �. r /, r ,•'t
NOTICE TO APPLICANT.-,, ,' 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
Ihereby 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 Address
City, State, Zip
REMARKS
oti3fQ') if fitW'/� t'i_'1� tti4 t 4
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. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CARP. SQ. FT.
WALL SO. 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
lKITCHEN 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
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ic
HOUSE SEWER
FRAMING �G
FINAL INSP.
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 GOND. 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 APPJEQUIP.
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 �G
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
:d
MEMORANDUM
TO: Ron Kiedrowski, City Manager
i
FROM: Tom Hartung, Building and Safety Director -77
DATE: November 7, 1991
SUBJECT: 46-855 Highland Palms
The above house is located in the R-1 zone and as such no
landscaping is required per the current zoning regulations. New
subdivisions located in R-1 zones are required to belandscaped by
virtue of the conditions of approval. Houses in -the SR zone (cove,
your area, and Bottlebrush) are required to have the front yards
landscaped.
I, think Jerry Herman has really dropped the ball -on -this one and
should be dealt with accordingly.
TH:es
cc: Jerry Herman .
MEMOTH2O
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