No Permit (BLCK)c&t,/ 4 4 Qum&
52
P.O. BOX 1504 APPLICATION ONLY
Building �°� , 7105 CALLE ESTADO.
AAArpsa �'�� �1��CC,-"41NI A, CALIFORNIA 92253
Mailing ok- I ��k,
Address6 �
Te
'y , D ZqL, -6 ,Q,19
Ad rebs 101
2-1 63 State Lic. TCLIC.
etyN27
& Classif.�G ��,6
"
Arch., Engr.,
Designer
Address
City IZip I Licta I
UCpIKEO CONTRACTORS OECLAMTION
I ase that I am licensed under provisions of Chapter 9 (comrrlerWh with Section
7f A at 3 0l the try license is in full tarp and
effect.
SIGHAT
O MNEWBUILOER MLARATIOII
I hereby affirm that 1 am exempt from the contractors License Law for the following
reason: (Sec. 7031.3.al"neas and Proissarq Gods: Any col, or corny Mulch reotles a
0rma to construct. after, ihprove, arrnsirh. or am any strUemag. PAW to as *guano ally
1e0urge Me aopaear for such panes to mea I a Scott i are Nw he a acense0 puRl/lf to
the provisions of n• Carwactor•s License Law. Chow 9 (commencov win s•emn 7000) d
Division 3 of the 91Isrnap and Proheeto IS Coda Or Met. he is WOW Morahan. and M• basis
nor de deoed exarrOW - Any W*Wlon of Saedon 7031.0 by any halt ` of for a prmf
sueyects the apWcanf to a ave pen sty of not more Men rive hwww doers (0000).
I• as owner of the property, or my employees with wages as their soba twmperaation, will
do the wart, and the structure is not int erhde'or offwed far sale. (Sec. 7044. Sugg"as and
Profpyons coda: The Contreetd►'0 Lune law does not &apse to an OWW Of property WOO
tiusda Of rrproves thereon aro wt apse such ware Missal ar ftouglr_Ml ori ofobreM.
provided that such iroroiemo o we no nrarald r olrW b Sala. N. however. the &Wdhg
or wiprovrrwu is sow when ori* vow at comajors rn. Me owe -&~ err have Me burden
of rovn0 trier me did nor Wild or nOrove for Me purpose of Sat&.)
: I, ai owner of the property. am exclusively contracting with licensed contractors to Carl.
struet the project. (See. 7044. 9usiness and Professions Cade: the Cbnmictor•s License law
does not atioh to an owner of property who bu** r impnd roves Morgan. awho corhtraeft for
such protects WRri a contractors) aeensea pursuant to the contractor's Licarm Law.)
i am exempt under Sec. S. A P.C. far this neesoin
Oae Owner
WORKERS! COMPENSATION OECLARATION
.I hereby atfirn that I have a conifkate atconsent to selMnsure. or a cwtill, tta at
Workers Compensation Insurance, or a certified copy thereon. (3ec. 3000. Labor Code.)
Policy NO. COMMIT
I Copy is filed with the city. C C•rtLMed copy is hereby fufnished.
CERTIFICATE OF EXEMPTIGN FROM
WORKERS COMPENSATION INSURANCE
(This so~ need net tie carnpisfe I r the partlR is for one Iki ndrod idem (0100) gtsebn
or revs.I
I c• City that in the performance of the work far ~ Me permit Is issued, I shall not
employ any person in any manner so as to beeohe subject to the Worker' Compensation
Laws of California
Oeto • Owner
NOTICE TO APPLICANT: f, after malting M4 cerMkate of Ex lam, you Should oacome
sued to the Nbraers' Compensation prowore of the Labs code. you Rapt lbmlwah
carroW ran autGh roviereru r art panne brat se earned nwaW.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that then Construction a eetruction landing agency for the peAOmence Of the
work for which this permit is issued. (See. 3097, CW C009.1
Lamers Name
Lender's Address
This is is' building
permit
Inco properly filled out. signed Slid vallCated, and is subject to
expiration if work there Zler 1 suspended for 190 days.
`I ceAity that 1 have reed this application ano state that the above information is correct.
I agree to comply with all city and county ardinanees and state laws relating to building
construction• and hem" authorize representatives -of tMs- city to enter the -bail.
mentim property for inspection purposes.
Signature of applicant Dab
Mailing AOOr•ss
City, state. ZiD
TYPE CONST. OCC. GRP.
Number
Description
i2o
Sq. Ft. No.
Size Sto
No. Ow.
New -f ' Add ❑ Alter ❑ Repair ❑ Demolition ❑
Em mated Valuation O v iJ
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Match.
Electrical
�Kl
Driveway Enc.
Infrastructure
AMOUNT
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:Gate Permit
Validated by:
Valldation
Ni'E v0 I ELE•_'71CAL "_ES vG ZIJMBIhG FEES
S UN'
c. I
MOBILEnCMF. i.
JC r
_
..-n l
-aP D c0 c-
OPA:NAGE PIO'NG
! -
1 ;BALL SC Fr
I I 'OPINM,!NG ")UN' -IN
i I SO FT =
I _'571MATE0 CC'4STRUCTICN VALVA -CCN S
I
;JPINAL
WATER 010ING
NCI :O :2 .SeO as CrOOerty tax #d1uahon
COLL. AREA
F=LOOR OPAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
. =VT SYSTEM =AN EVAP :JCL HOOD
SIGN
WASHEPtAUTOnOISH,
IPVLIANCE DRYER
DUCT WORK
IGARBAGE DISPOSAL
=,jPNACE UNIT WALL FLOCR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
1,R nANOLING UNIT CFM
OTHER APPJEOUIP.
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE.TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
I AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT ,; c
BATH TUB
GRADING
cu. yd.
SO. FT. c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U. -
SO. FT. RESIO it IV/* c _ _
SEWAGE DISPOSAL
_.
SO.FT GAR it I.c
MOUSE SEWER
--
—
-- -
- - -
-- — y
GAS PIPING
-EgMIT FEE
PERMIT FEE
PERMIT FEE
GBL
TOTAL FEES
_. MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT FEE
SMI FEE PLUMB. FEE
_...._.STRUCTURE . ._ _.. PLUM13ING . ELECTRICAL NEATING&AIR COND. SIOLAR
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 WINAU
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT -
WATER NEATER
SERVICE
FINAL INSP.
BOND BEAM 3
WATER SYSTEM
GRADING
cu. yd.
LUMBER GR;
- -
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
--
—
-- -
- - -
-- — y
R[MARKS:
VENTILATION
FIRE ZONE ROOFING -
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL -
LATHING
MESH
INSULATIONISOUNO
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INYECTOR'S 3NiNATURESUINITU1l3
GARDEN WALL FINAL