003521 (BLCK)�. P.O. BOX 1504 Wo: 003521
Building78-105 78-490die Oren.se LA QUINTAC
Address CALIFORNIA 92253
Owner
CasiMl Rom Nwera Association BUILDING: TYPE -CONST. OCC: GRP. - '
' 'Mailing -
Address P* 0* Box 11€ 617-442-J�-€ 09
" A.P. Number
City Zip Tel.
.. ..jd Qvint a 92253 .56:.4-2177 Legal Description
Contractor31of 6° high ebaly..l.i-Jak £ease
Alldod 'Fe ''Comes- Clop .
Project Description
...Address _. .. .... .._. , ..
:&h.-5' ' 6.• Sate.
pe ov Box 515
City, . .... . .. ....... Zip_ Tel." c- .
�tt[4paxtt �s�it�Ysry . nFa 4 9A7o %f�99 9
State. Lic. lCity
& Classif. 274095 Lic. # Sq. Ft. No. No. Dw.
-Arch., Edgr., ... :.. _..
Size -.Stories Units
DesignerNew ❑ Add ❑ Alter ❑ Repair ❑ Demolition
Address
Tel.
BY: -
• 'subject' to the' Workers' Compensation provisions' of the Labor Code; you must forthwith
comply with such provisions or this permit shall be deemed revoked. • '
City
Zip
State
Lic. #
Fr,ont.Setback.from.Center Line
• LICENSED CONTRACTOR'S DECLARATION
• I hereby affirm thatel am licensed under, provisions of Chapter 9 (commencing with Section
70 OO) of Division 3 of the Business and Professions Code,. and my license is in full force and'
effect..
Rear Setback from. Rear Prop. Line
SIGNATURE DATE
OWNER;BUILDER DECLARATIONEstimated
hereby affirm that I am exempt from the Contractor's License Law for the following.
. reason: (Sec. 7031.5,Buslness and Professions Code.: Any pity or. county which requires a..
permit to construct, alter, Improve, demolish, or repair 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'Busine'ss and Professions Code; or that. he is exempt therefrom, and the basis' -
for the alleged' exemption. Any violation -of Section 7031.5 , by' 'any applicant for a .permit
subjects the'applicant to a civil penalty of not more than five hundred dollars ($500).
O 1, as owner of the property, or my_employees with wages as theitsole compensation, will
do -the work, and'the structure is not intended or offered for sale. (Sea"7044, Buisness and
Professions Code: The Contractor's License Law does not apply toan-owner of property who.
builds, or improves thereon and who does such work himself orthroughhis 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.) •. ..
.0 .1, 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.) ..
O Lam exempt under Sec.. -B. & P.C:.for this reason
_ _- •. .. _ _ . ,_ - .
Valuation
41,
- PERMIT
'
- . Plan .Chk..Dep..
-
Plan Chk. Bal. .
Const.
: Mech.
'
Electrical
'
Plumbing. • . -
_
S.M.I! -
.
Grading
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have 6'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 completedif the permit is for one hundred dollars ($100) valuation
or less.) .. .. .. .. -
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 '
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.
"county
TOTAL
REMARKS,
agree to comply'with all city and ordinances .and state laws relating to building
;r+
AMOUNT '
S7_o 16
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become
ZONE:.
BY: -
• 'subject' to the' Workers' Compensation provisions' of the Labor Code; you must forthwith
comply with such provisions or this permit shall be deemed revoked. • '
Minimum Setback Distances: - - -
Fr,ont.Setback.from.Center Line
a '
Rear Setback from. Rear Prop. Line
CONSTRUCTION LENDING AGENCY
'
Side Street Setback from Center Line
Thereby affirm"that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
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.
"county
Issued, by:
Date !jfs r, /R7 Permit
agree to comply'with all city and ordinances .and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
A.C. UNIT
2ND FL. SQ. FT. ®
SLAB GRADE
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT. ®
DRAINAGE PIPING
WALL SO. FT. ®
DUCT WORK
DRINKING FOUNTAIN
SQ. FT. ®
GAS (ROUGH)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
REINF. STEEL
GAS (FINAL)
-
TEMP. POLE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT. WALL FLOOR SUSPENDED
WATER SYSTEM
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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 ® 11/4 c
SEWAGE DISPOSAL
FIRE ZONE ROOFING
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FIREPLACE
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEEPL.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 APPJEQUIP.
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
t
,
„ w
'! DEC
`
17 198
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