003637 (SATT)Buildin
Address 55-837 Congreso
Mailing -
Address 75,.005
City
Contractor
Address _
Zip
.. 3225
City IZip
State Lic.
& Classif. 288130
Arch., Engr., -
Designer•
Address
BUILDING: TYPE CONST.
`,club ifi& A.P. Number PGA. WI
Tel.
�. Legal Description
Project Description Pias
Tela
Lic. #
Tel.
No. 003637
OCC: GRP.
St
e 6B., Plan 3€ MR,
328. . _ _ Sq. Ft. DRIC 2825 No.
Size: $ Stories
New ❑ Add ❑ 'Alter ❑
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirTfthat 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
No. Dw.
Units
Repair ❑
Demolition ❑
OWNER -BUILDER DECLARATION
Estimated Valuation
Minimum Setback Distances:
I hereby affirm that I am exempt from the Contractor's License Law for the following
'�
$1941'r692
reason: (Sec. 7031.5, Business and Professions Code: Any city or county which requires a
i�� d
..
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
- :r
' Division 3 of the Business and' Professions Code, or that, he, is exempt therefrom, andlhe basis
for Any Section 7031.5 by 'any for
Plan Chk. Dep.
Date Permit '
the alleged exemption. violation of applicant a permit
' -subjects the applicant to a -civil penalty of not more than five hundred dollars ($500). -
Plan Chk. Bal.
.
e '
` 1
0.1, 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, Bulsness and
Corlst.
Professions Code: The Contractor's License Law does not apply to -an owner of property who
'
f •(�
"builds or improves thereon and who does such work himself or through his own employees,
Mech.
00"
provided that such improvements.are (;of intended or.offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have theburdenElectrical
121.71 -
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
136.50
struct the project. (Seca 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. .
13.62
such projects with a-contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. B. R P.C. for this reason
Driveway Enc.
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
❑ Copy 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, l shall not
employanyperson 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 it 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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
HARD COPY
Infrastructure 4:380.57
TOTAL
REMARKS 'N^e n.+ 4 06 -an jz{ A tt .'+nt,t
PJ -1 _11R�tf
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. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
FOR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SQ. FT.
GROUT
WATER HEATER
WALL S0. FT.
FINAL INSP.
DRINKING FOUNTAIN
SQ FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1'A c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
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
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 APP.IEOUIP.
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
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