002737 (SFD)TW�t 4 4Qur«rw
Building 5,3„.3955 Avenida �$ta3
Address
Owner
Y Mier
Mailing
Address
City Zip
..
328-6691
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION _
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
71X)0) 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 affirm that I am exempt from the Contractors License Law for the following
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 -
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
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 penafty of not more than five hundreddollars (8500).
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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or tmproves 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
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.) -
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 704.4, Business and Professions Code: The Contractor's LicenseLaw-
does not apply to an owner or property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & 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 a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O Copy is filed,with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
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
No. 002737
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 77"9-5-019
Legal Description lot a
Project Description's
Sq. Ft. GM 420 No. No. Dw.
Size Stories Units
New ❑
Add O Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
r. nn nnti nn .
PERMIT
AMOUNT
Plan Chk. Dep.
250.00.
Plan Chk. Bal.
72.93
Const.
376.00
Mech.
36.00
Electrical
77.35
Plumbing
1.03.00
S.M.I.
5.64
Grading
20.00
Driveway Enc.
20.00
Infrastructure.r.0
Lender's Address
FINAL DATE
INSPECTOR
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.
TOTAL
2,150.91 1,900.`41
REMARKS
Issued by:.
Date ermit
I agree to comply with all city and county ordinances and state laws relating to building
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 must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:
Front Setback from Center. Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
I 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 Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
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.
12-3—SSe
I certify that I have read this application and state that the above information is correct.
Issued by:.
Date ermit
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..
Validated by:
if
Signature of applicant, Date `
Mailing Address 1
Validation:
City, State, Zip
A685%_
12 + i,9 ,0,91 Ch
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
,�L,�LAS GRADE ./2
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
4�6RMS 2
ER OR SEPTIC A
IiIII
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT. ®
OTHER APPJEOUIP.
DRAINAGE PIPING
WALL SO. FT.
PEMP. POLE /C
DRINKING FOUNTAIN
SO FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
LUMBER GR.
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
!�
/�!/
pJfj�i00FING j✓�_G�l/ /�
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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
i
NSULATION/SOUND Z
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
• FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
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
ETBACK liL /�
ROUND PLUMBINGg,�45t,UNDERGROUND
A.C. UNIT
COLL. AREA
,�L,�LAS GRADE ./2
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
4�6RMS 2
ER OR SEPTIC A
IiIII
ROUGH WIRING
DUCT WORK
ROCK STORAGE
4GfZOUND. REINF. l2 .12- g�
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
4iy EINF. STEEL 2 • 67 �w'd
GAS (FINAL)(
PEMP. POLE /C
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ —Plus—x$—=$
LUMBER GR.
al FINAL INSP. /-J
ING
FINAL INSP.
!�
/�!/
pJfj�i00FING j✓�_G�l/ /�
�/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
WLATHING
MESH
i
NSULATION/SOUND Z
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
• FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL