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002480 (SATT)4 4. . 4 . P.O. BOX 1504 Building ss LA QUIN � OTA Address CAL CALIFORNIA 92253 Addr Owner C,,1MT*k9 nvorvrm No. 002480 Mailing BUILDING: TYPE CONST. OCC: GRP. - ' Address 75-0115 CY=try Chb'DriVa A.P. Number, City lZip ITel. contractor Address. m City lZib Tela State Lic. & Classif. 2ftl3o Lic. # 328 Legal Description Project Description P_C _A_ MR EMM, I C EA r .Y.3.23,a 300 C: . v Mr. 3.971 Sq. Ft. No. No. Dw. Size 7M...657 Stories Units Arch.; Engr., Designer New ❑i, Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. Rear Setback from Rear Prop. Line Side Street Setback from Center Line City Zip State Lic. # .. FINAL DATE INSPECTOR LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 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. Date 7"43-9 Permit Validated by: SIGNATURE,!` t''`. i - DATE OWNER -BUILDER DECLARATION' I hereby, affirm that-1,am exempt from the Contractors License Law for the following 7031.5,Business' and Professions Code: Any -city or county- which requires a reason: to 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 thaLhe is"exempt-therefrom, and the basisr for the alleged. exemption. Any violation of Section 7031.5 by 'any applicant fora _permit " subjects the applicant to a. civil penalty oPnot 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, 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.) O 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.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Estimated Valuation 2-90,844.00 - ..PERMIT AMOUNT - Plan Chk:. Dep.rJC,�• .Plan Chk. Bal. Const. ¢ �itiJ J� • V Mech.. �•� Electrical Plumbing 148.50 S.M.I. ��• Grading Driveway Enc. Date Owner Infrastructure 2.000.00 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 statelaws 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 t City, State, Zip % HARD COPY 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 DATE INSPECTOR Issued by: Date 7"43-9 Permit Validated by: Validation:— alidation:Ab1U5 A6105 7 31 3 b I:� 4 8 Ch CONSTRUCTION ESTIMATE NO. ELECTRIC - S NO. PLUMBING FEES IST FL. SQ. FT. UNITS SLAB GRADE 2ND FL. SQ. FT. BONDING YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. GAS (ROUGH) DRAINAGE PIPING WALL SQ. FT. OTHER APP.IEOUIP. DRINKING FOUNTAIN SQ FT ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL GAR. FIREWALL SQ.FT.GAR ® 3/ac HOUSE SEWER LATHING 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