002473 (SATT)Building
Address
Owner
Mailing
Address
City
U 4 1, C*
P.O. BOX 1504 N o . 0/ _9473
920 P LA QUINTAC
X35CALIFORNIA 92253
Zip Tel.
D&Swt 92260 SC$ -2 28
Contractor
Natl Wig, wid Lind
Address
BUILDING: TYPE CONST.- OCC: GRP.
A.P. Number
Legal Description
Project Description P.G.A�l�qo �s1MTim �(�Ae� a2.0
Sam
BY:
Minimum Setback Distances:
' City ]Zip
Front Setback from Center Line
Tel.
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback -from Property Line
FINAL DATE
State Lic.
City
Mn 4263
Validated by:
& Classif.
Lic. # 32�
Sq. Ft.
No. No. Dw.
A6099
Size -
Stories Units
' Arch., Engr.,' -
Designer
New OK Add ❑
Alter ❑ Repair ❑ Demolition ❑
'Address
Tel.
City
Zip
State
.
- -
Lic. #
-
LICENSED CONTRACTOR'S DECLARATION
I hereby.affirm that I am licensed under provisions of Chapter 9 (comrilencing'with Section
7000) of Division 3!of the Business and Professions Code, and my license is in full force and
.effect... -• I'. r .. - _-r,. •-�' ..
-
SIGNATURE '* - DATE
OWNEWBUILDER DECLARATION
I hereby -affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
�q�� q /�
$ 267-iQ7 6' 00
reason:, (Sec. 7031.5,Business and Professions Code: Any city or county .which requires a
permit to construct, alter, improye, 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
'
Division 3 of'the Business and Professions Code, or thaLhe'is exempt therefrom, and the basis
' for the Any Section 7031.5 by any for
Plan Chk. Dep.'-
alleged exemption. violation of applicant a permit
subjects the applicant to'a civil penalty of rot more than five hundred dollars ($500).
Plan Chk. Bal..
4-53-219
❑ 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
Const.
JwiiLt
Professions Code: The Contractor's License Law does not -apply -loan owner of property who
builds or improves thereon and who does such work himselfor through his own employees,
Mech.
_ 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 will.have the burden
Electrical
of proving that he did not build or improve for the purpose of sale.) _ ,
..1 •-
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
'�
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
S.M.-I.
i 7
- such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) --
Grading
'
D 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
I�..✓Qs.
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
.0 Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ii 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 arty 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.
1 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
bovementioned property for -inspection purposes.
Signature of applicant - Date
Mailing Address f` r
City, State, Zip
HARD COPY
TOTAL 3,955.07
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 -23 -Pe rm it
Validated by:
Validation:
A6099
7 31 .3iI,)
CONSTRUCTION EStIMATEdilk
NO. ELECTRICAL S
NO. PLUMBING FEES
1ST FL. SQ. FT. @
2ND FL. SQ. FT.
FOR. SQ. FT. @
GAR. SQ. FT. @
CAR P. SQ. FT. @
WALL SQ. FT. @
SQ FT @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 114 C
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
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.IEQUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESANITIALS
GARDEN WALL FINAL