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09197 (RPL)r til ` . ri Building Address Owner P.O. BOX 1504 _ _ ` N o . 09197 Mailing Address 51-265 Palma City I Zip Tel. Tel.: I City Lic. # Tel. State Lic. # •• DECLARATION Chapter 9 (commencing with Section Code, and my license is in full force and. DATE TION. or's License Law for the following' Any city or county :which requires a structure, .prior to Its-issuancealso statement that he is licensed pursuant -to (commencing with Section 7000) o/ is exempt therefrom; and the basis 1.5 by 'any applicant for a permit hundred dollars ($500). es as.their sole compensation, will for sale. (Sec. 7044, Buisness and apply to an owner of property who sell or through his own employees, d for sale. 1/, however, the building owner -builder will have the burden e. ) g with licensed contractors to con- Code: The Contractbr.'s License Law, over thereon, and .who contracts /or, Contractor's License Law:) - s reason r i DECLARATION • t to self -insure, or a certificate of " thereof. (Sec. 3800, Labor Code.) erebyfurnished.- N FROM . ' INSURANCE one hundred dollars ($100) valuation ch this permit is issued, I shall not subject to the Workers' Compensation. of Exemption you should become e Labor Code, you must forthwith revoked. AGENCY ' agency for the performance of the ) ed and validated, and is subject to t the above information is correct. and. state laws relating to building this city to enter the above-. Date Contractor City Zip State Lic. LICENSED CONTRACTOR'S I hereby affirm that lam licensed under provisions of 7000) of Division 3 of the Business and Professions Cod effect. SIGNATURE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contract reason: (Sec.. 7037.S,Buslness and Professions & Classif. Arch., Engr., Designer Address City Zip P. Numbel Legal Description Project Description- $i3i31 �lHCZ �'D.� Code: 12-041(1 permit to construct, alter, improve, demolish, or repair any • requires the applicant for such -permit to file a signed the provisions pl the Contractor's License Law, Chapter 9 Division 3 0/ the Business and Professions Code, or that. he for the alleged exemption. Any violation of Section .703 s� bjacfs the applicant to a civil'penalty of not more than live :� I, as owner of the property, or my employees with wag do the work, and the structure is not intended or offered Professions 'Code: The Contractor's License Law does not builds or improves thereon and who does. such work himself provided 'hat' such improvements are not Intended or offered or improvement is sold within one year of completion, the ol.provtny that he did not build or improve for the purpose o/.sal I,'as owner of the property, am exclusively contracting •,slrugt the project (Sec. 7044, Business and Professions does not apply to an owner o/ proper4,1 ty who, builds or improves such protects with a contractor(s) licensed pursuant to the ❑ I am exempt under Sec. ! ��yy B. 8 P.C. for this Date Owner.` :ii L`� c Alp �_ ._ , k,.� •-.,. _. WORKERS' COMPENSATION " I Hereby affirm that I have a.certificate-of consent Worker's Compensation Insurance, or a certified copy PolicyNo�•��+ � �� .-Company �Copq'is`filed with ttie city. ❑Certified copy is h CERTIFICATE OF EXEMPTIO • WORKERS' COMPENSATION (This section need not be completed i/ the permit is /or or less.) I certify that in the performance of thg work'for which employ any person in any manner so as to become Laws of California. Date Owner NOTICE TO APPLICANT: If,. alter making .this Certificate subject to the Workers' Compensation provisions o! th comply with such provisions or this permit shall be deemed • CONSTRUCTION LENDING I hereby affirm that there is a construction lending 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, sign expiration if work thereunder is suspended for 180 daysr I certify that I have read this application and state that I agree to comply with all city and county ordinances construction, and hereby authorize representatives'�of mentioned property for inspection purposes. Signature of applicant Mailing Address City, State, Zip Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. - (;n Mech. g Electrical A A41 - Plumbing 1 {+1 S.M.L .- A a ,P.=K�af ��t�Y.ro+Yi•2'. �l�r.7�Ktiv..9�• i��"..�'•'4 ia n.Ne�n.�y 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: 2�a1 Grading Driveway Enc. ' Infrastructure TOTAL q. q q REMARKS • a ,P.=K�af ��t�Y.ro+Yi•2'. �l�r.7�Ktiv..9�• i��"..�'•'4 ia n.Ne�n.�y 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: 2�a1 CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS COLL. AREA 2ND FL. SO. FT. YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. SO. FT. DUCT WORK ' DRAINAGE PIPING WALL SO. Ff. DRINKING FOUNTAIN. SO FT. ® HEATING (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ WAIER PIPING NOTE: Not to be used as property tax valuation 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 GRADING cu. yd. $ plus x$ LAUNDRYTRAY AIR HANDLING UNIT CFM FRAMING 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. SO. FT. ® c BATH TUB SO. Ff. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. Fr. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER GAR. FIREWALL 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 01 GROUND PLUMBING djf0 UNDERGROUND L 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 �� LP METER LOOP 6 HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. FINAL INSP. !� 7 R GRADING cu. yd. $ plus x$ _$ LUMBER GR. FRAMING ROOFING � � Pj �rey , it�y r d/7fq REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION 10 It 711( CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL