04535 (SFD)7 (qfo - 4 4 Qum&
"Zh
Ve' Tp1 1 .� . r.. .l" .t. rt 9
' P.O. BOX 1504
Building 1UFRnuAaana Rosa I e 0IIIKITA r..AI IO998;1
Address
Owner
to Qu nta Joint. Vent
Mailing
Address 1'» 0. Box 790
City Zip Tel.
Li Quinttt 1 32253 564-1'3-15
Contractor
Address
City lZip Tel.
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State I
Lic. #
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.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, of 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) o/
Division 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by any applicant /or a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (8500)
O 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
o/ proving that he did not build or improve for the purpose of sale.)
15I, as owner of the property, am exclusively contracting with licensed contractors to con-
stittct 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 contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. 8 P.C. for this reason
;
Date`;fr� 7 � Owner ',4?—
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. ❑ 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.
BUILDING:' TYPE CONST. OCC. GRP.
A.P. Number 01--730-007
X45.33
h
Legal Description
Project Description IS64261 I(';6T?xlIDIOX *A" P14n
Sq. Ft. 3720 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition O
.w>
Estimated Valuation $25a,544
PERMIT
AMOUNT ,
Plan Chk. Dep.
$250 00
Plan Chk. Bal.
8 421.55)
Const.
330.54
Mech.
39.00
Electrical
124.91
Plumbing
127.00
S.M.I.
18.14
Grading
Driveway Enc.
Infrastructure
AM ,t A^ R
TOTAL
'd a t . s -2,72 :xi t9
REMARKS
iii 9.T9�rY i YKFisii.. � rvsv.�4
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) 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. 8/19/08
I certify that I have read this application and state that the above information is'correct. Issued by: Date Permit
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 property for inspection purposes. Validated by:�
Signature of applicant Date
Mailing Address Validation: -
City, State, Zip l ;
�i WHITE - FINANCE, PINK;, APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATL
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO F1 (a S
UNITS
SLAB GRADE
ROUGH PLUMB
G / LJ--"
YARD SPKLR SYSTEM
2ND Fl SO FT. a
FORMS
SEWER OR SEPTIC TANK
O WIRINC�/2�2Zft
�" [C.JJ
MOBILEHOME SVC.
BAR SINK
POR SO FT. ar
zo
GAS (ROUGH)
METER LOOP
HEATING (FINALI
POWER OUTLET
ROOF DRAINS
GAR SO. FT. fp
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT. Q
FINAL INSP.
WALL SO. FT. @
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu. yd.
$ PIUS x$
=$
URINAL
SO. FT. a
ING /� LZ��p
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
rC� '—wr,, f
(J /�/yJ
WATER PIPING
NOTE: Not to be used as Property tax valuation
REMARKS:
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTONDISHI
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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.
SO. FT. a c
BATH TUB
SO. FT. c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID 1+i c
SEWAGE DISPOSAL
FINAL INSPECTION
SO.FT.GAR fg 3i c
HOUSE SEWER
CERT. OCC.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE '
DBL
TOTAL FEES
MICRO FEE
MECH.FEE EPL.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
G / LJ--"
HEATING (ROUGH)
STORAGE TANK ,
FORMS
SEWER OR SEPTIC TANK
O WIRINC�/2�2Zft
�" [C.JJ
DUCT WORK
ROCK STORAGE
FOUND. REINF.
zo
GAS (ROUGH)
METER LOOP
HEATING (FINALI
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ PIUS x$
=$
LUMBER GR.//��
FINAL INSP.
ING /� LZ��p
FINAL INSP.
ROOFING
rC� '—wr,, f
(J /�/yJ
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR -
GAR. FIREWALL
ING b,p
MESH
J�S b4TIONISOUND1ZiNISH
GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
,
GARDEN WALL FINAL