04752 (SFD)Building
Address'=,.
Owner S
5 Bottlebrt2sh
Mailing
Address . '9'(3 Ec�Qitre Y)r91-y1
City Zip T
Torrance 90503
Contractor
Owner/Builder
ress
4
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253 -
Las BUILDING: TYPE CONST. OCC. GRP.
A.P. Number 617-3324006
213-.316-3166 Legal Description
Project Description S * P, D.
City jZip ITel.
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 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
F OWNER -BUILDER DECLARATION
I hereby affirm 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, 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) 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 (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 improves 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. 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 License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
Dale 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. O 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 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
NOTICE TO APPLICANT: If, 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
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.)
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
04752
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 DATEqINSPECTOR
*1/1�/4@@19
Issued by: Date Permit
Validated by:
Validation:
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
Sq. Ft. 1514
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$81,421
PERMIT
AMOUNT
Plan Chk. Dep.
�250+00
Plan Chk. Bal.
74.90
Const.
379.00
Mech.
315.00
Electrical
76.95
Plumbing
103.00
S.M.I.
5.64
Grading
20.00
Driveway Enc.
20.00
Infrastructure
l r797,iii
Frtnge -Toea
Uzara tee
00001
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 DATEqINSPECTOR
*1/1�/4@@19
Issued by: Date Permit
Validated by:
Validation:
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATL
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL . SO FT rp S
UNITS
COLL. AREA
(
y
'CAB GRADE �`�r1 .
YARD SPKLR SYSTEM
2ND FL SO FT. R
HEATING (ROUGH)
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR SO FT &
DUCT WORK
ROCK STORAGE
POWER OUTLET
ROOF DRAINS
GAR SO. FT. a
HEATING (FINAL)
OTHER APP.IEOUIP.
.STEEL e
DRAINAGE PIPING
CAR P. $O FT. Ca
WALL SO. FT. a
GROUT
DRINKING FOUNTAIN
SERVICE
FINAL INSP.
URINAL
SO. FT. (a
BOND BEAM
WATER SYSTEM
ESTIMATED CONSTRUCTION VALUATION $
GRADING
cu. yd.
$ plus x$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVARCOOL HOOD
SIGN
WASH ER(AUTOXDISHI
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRYTRAY
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
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID g- 11i c
I ISEWAGE DISPOSAL
SO.FT.GAR 3i c
MOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE hL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
QUND PLUMBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
(
y
'CAB GRADE �`�r1 .
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EW SEPT`-fx
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
r
R LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
.STEEL e
GAS (FINAL)
loo TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
= $
LUMBE GR.
FINAL INSP.
91S.4 -
FINAL INSP.
NG Z�J
^
y/vim)
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
`
FINAL INSPECTION?�,�i m
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
,
GARDEN WALL FINAL
HAMMER PUMPING INC. JOB INVOICE
P.O. Box 2448
CATHEDRAL CITY, CALIFORNIA 92235-2448
I (760) 360-7448
(760) 321- 7448 CUSTOMER'S ORDER NO. BATE OWrRED
ORDER 7AKFN BY DA7E PROMISED ❑ A.M
BILL TO r ❑ P.M.
PHONE
ADDRESS
MECRANIC
LHELFER
�L-DC
J08 14AMSi-
+
❑ DAY WORK
DESCRIPTION OF WORK
r-. ❑ CONTRACT
❑EXTRA
E �
UAryT_ DESCRfPTION OF MATERMAL 113Cp
PRICE AMOUNT
Gallons
., Pumping Fee per 1000 gal.
s.
F Dumping Fee per 1000 gal.
e
Out of Area Fee
Locating / Opening Fee (per hour)
Size system:
A SERVICE CHARGE OF $20 WILL BE DUE
ON ALL RETURNED CHECKS.
18%, PER YEAR WILL BE CHARGED ON
PAST DUE ACCOUNTS OVER 30 DAYS.
]Of•'; LA33OR
i
MECHANJCS C
HELPERS -
�.,r
�f
I hera4y acknowledge the s
completion of the above r TO TAL LABOR
TOTAL
MATERIALS
TOTAL
LABOR
TAX
CTEp
TOTAL