10041 (RPL)I
P.O. BOX 1504
Building 44--095 Calico LA QUINTAC
Address CALIFORNIA 92253
Owner
meve Reeder
Mailing BUILDING:' TYPE CONST
Address same
A:P. Number
City La Quintal.Z1p92?53 ?
~ Legal Description
Contractor
OR a Palm Enterpii5e
Primavera
Cat -City -92234 325-•23.37
State Lic. City
& Classif. C27/53 591925 Lic. # 1888 -
Arch., Engr.,
Designer
Address Tel.
City 1 Zip State
Lic. #
>> 1 LICENSED CONTRACTOR'S DECLARATION
I perefyy' affir0m that"I am Ilcensed under provisions of Chapter 9c(commencing with Section
�000 of`Division 3 of�She Businessland Professions Code, and my license is in full force and
/effect. 'tt \ 1i�41 y t`tiiil "` P.\i1 r r .�
OWNER -'BUILDER DECLARATION
I hereby affirm that I am exempt4r ,thel Contractor's License Law for the following
reason: (Sec. 7031.5,Suslness and Professlods Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
the provisions or 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 or 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, Bufsness and
Professions Code: The Contractor's License Law does not apply to an owner of properly 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 or completion, the owner -builder wig 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 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.)
PolPro. Company
opy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(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
=anyliFerson in any manner so as to become subject to the Workers' Compensation
California.
Date Owner
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you shouki 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
Project Description
No. 10041
OCC: GRP.
POOL AND SPA
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Aimated Valuation
12, 6OO
- PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal:
93.50
Const.
144.00
Mech.
24.00
Electrical
45.00
Plumbing
27.00
S.M.I.
1.30
Grading
Driveway Enc.
Infrastructure
TOTAL
10334QW 4
ILI HL I tiS=g.'itlt
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 DATE
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
PLUMBING FEES
IST FL SO. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
YARD SPKLR SYSTEM
F
2ND FL SQ. FT.
' ROUGH PLUMB.
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
FO S
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
DRAINAGE PIPING
CAR P. SQ. FT.
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
OTHER APPJEQUIP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GROUT
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR ' SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SQ. FT. ® c
BATH TUB
REMARKS:
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 Vic
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
FIREPLACE
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
D PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
B RADE —�/
4-4
' ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FO S
SEWER OR SEPTIC TA K
ROUGH WIRING
DUCT WORK
ROCK STORAGE
D. REINF./
✓
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
T P. POLE
GROUT
WATER HEATER
RVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP ��
FRAMING -�
r
FINAL INSP.
OFING .�..-%
� �
�
/ �s/JJ
_i7
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL