002411 (PAT)Atif
44
P.O. BOX 1504 N o .
Building53-340 Atg ,p
Address " LA QUINA, CAL FORNIA 92253
Owner
BUILDING: TYPE CONST. - OCC: GRP.
-
Address sam A.P. Number 77482-005
City Zip Tel. � .. . .
92253 %4-2817 Legal DescriptionEck 20
Contractor Project Description
Address . _.
City. Zip" Tela
Nile,•
State Lic. City
& Classif.- Lic. # Sq. Ft. No No.
U No. Dw.
Arch., Engr.. Size 22 + o ..
d' nits
Designer New Ek Add ❑ Alter ❑ Repair ❑ -Demolition ❑
Address Tel. _
City Zip State
Lic. #.-. o c
LICENSEDCONTRACTOR'SDECLARATION
hereby affirm that I am licensed under provisions of Chapter9 (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 '
reason:, (Sec. 703 (.5,Business and Professions Code: Any .city or county .which requires .a -
permit to construct, alter, improve, demolish, or repair. any• structure, prior - to itsissuancealso
requires the applicant, for such permit to file a signed, statement that he is licensed pursuant to i '-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.•
subjects the applicant We civil penalty of "not more than five hundred dollars ($500): .. .%-
property, y p y 9 p Plan Chk. Bal. 2+�g cy+ys
❑•1, as owner of the or m em to ees,wilh wages as their sole. compensation, will 6:S•02
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 COt1St
, an owner,of property who - 38.50
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'wilhin 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.)
❑ I, 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
such projects with a contractor(s) licensed pursuant to the Contractor's LicensewLaw.)
O 1. am exempt .under Sec. B: & P.C. for this reason Grading
Driveway Enc.
Date�--Owner ;f'd t� 1 _ �' Infrastructure
WORKERS' COMPENSATION DECLARATION f '
I' ll"by'affirm that I have a certificate of consent to self-insuire, or a certificate of. u
Worker's ompensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.) - -
Policy No: ' company
❑ Copy isjiled with the city. O Certified copy is. hereby, furnished.
TOTAL 64.0
CERTIFICATE OF EXEMPTION FROM REMARKS.
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 r .
NOTICE TO APPLICANT: If, after making. this Certificate of Exemption you should become ZONE; `BY:" '
subject to the' Workers' Compensation provisions- of the Labor Code, you mush forthwith .. Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. - -
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
hereby affirm 'that there is i construction lending agency forthe performance of the
work for which this permit is issued. (Sec., 3097, Civil Code.) 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. Issued by: Date Permit
I- agree to comply'with all city and county ordinances and state laws relating rto building
construction, and hereby authorize representatives -of this city to enter the above.. - ..
mentioned property for inspection purposes. Validated by: '
Signature of applicant �.^- + Date
Mailing Address AV t Validation:
City, State, Zip
A5%84 6 .11 64,62CK
HARD COPY _ ..
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
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
OUGH PLUMB..
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
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
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/ac
HOUSE SEWER
r!{ FRAMING
11
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE JELECT.FEE
----j
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING jl
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
OUGH PLUMB..
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPT
vv
OUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
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. /
f�f
r!{ FRAMING
11
FINAL INSP.
ROOFINGS 1 ,' �i�
11 CC
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
r�
l(� LATHING
MESH
INSULATIONISOUND
i
FINISH GRADING
FINAL INSPECTION S
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES11NITIALS
GARDEN WALL FINAL
I t" p pj wwKu- S, a--�f T�