14331 (SFD)P.O. BOX 1504 N o . 14 331
Building 79_,.300 Citrus78-495 CALLE TAMP.ICO
Address LA OUINTA, CALIFORNIA 92253
Owner
Bradley Smith HO' Do VN OCC: BUILDING: TYPE CONST. ' : OCC:.GRP.
Mailin
Address 769-6-90-007
A.P. Number
City Zip Tel. 1,6t 17 Tracy 24890-7
1( Legal Description
Contractor
Ranobo - Capistrano Devsiopment
Address ....
79-689 Country Club Dr. 9201
(��rmu a tunes, % 922€ 1 . T.ek19) 345-$75
State Lic. 5597975' City 1969
& Classif.-. Lic. #
Arch.; Engr., �.�.C.- Ak6hi'tects
Designer
Aledireeyr orate Park Te(710 261-1.79
t iny, tv ► ZipStateuta C-6895
-LICENSED CONTRACTOR'S DECLARATION r
I hereby affirm that'I am licensed under provisions,of Cha tev9 (commencin h Section
7000) of Division 3 of the Business and ProfessionsrC eanpdmy li+cense•in•full force ander
effect.�/ /
OWNER•BUILDER DECLARATION��
1 hereby affirm that I am exempt from the Contractors•License•L•avi^for^the^following
reason: (Sec. , 7031.5, Business and Professions Code:. Any. city or: county, which requires a
permit to construct, after, improve, demofish, or repair .any structure, -prior to" its issuance also
requires the applicant for such, permit to rile 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 Business 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 rive hundred dollars ($500). • .
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,Cordractor'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
orimprovement is sold within one. year of completion, the owner -builder. will have the burden
of proving that he did not build or 'reprove for the purpose or sale.)
O 1, as owner of the property, am exclusively contracting with licensed contractors -to con-.
slrucl 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) (rcensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec - B. & P.C. for this reason
Date Owner
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.
❑ Copy is filed with the city, O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the work•forwhich•this permit is issued; I shall not
employ any prson in any manner so as to'become subject to -the Workers' Compensation
Laws of Cal ifeornia
i Date Owner
• NOTICE TO APPLICANT: It, after making this Certificate of Exemption you should beeome
subject to the Workers' Compensation provisions of the Labor Code, 'you must forthwith
' comply with such provisions or this permit shall be deemed revoked. - -
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEYS FEES.
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state'that the -above information is correct. .•
I 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 -'.hereby
mentioned property for ins_ pmtion purposes-
! Signature of applicant Date
`Mailing Address
. City, State, Zip _
Project. Description SFD •
ZONE:
BY:
Minimum Setback
Sq. Ft. 3826 , .
SizeStories
No.. r
�'''
No. Dw.
Units
New ❑ Add ❑.
Alter ❑ Repair ❑ Demolition ❑
Side Street Setback.from Centel Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
'.Issued by: -
Date -Permit - -
Validated by:
u `-
Validation:()
.
-SZ 101714
_
Estimated Valuation '"'•
319 { (6si�
PERMIT,
AMOUNT
Plan Chk. Dep.
•�
Plan Chk. Bal.
�; •
Const.
�.
L wv, .
Mech.��•
tl
Electrical
G3 7
Plumbing
N 0100
Grading
zu -ti3U
Driveway Enc.
• 00
Infrastructure
-b, UU U • UU
71rVa In 17i—W! C Places.
TOTAL
a' 3 •
r ` • -
REMARKS -
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from .Center Line
Rear.Setback from Rear Prop. Line
Side Street Setback.from Centel Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
'.Issued by: -
Date -Permit - -
Validated by:
u `-
Validation:()
.
-SZ 101714
_
I
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. Ff. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SQ. FT. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT. ®
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
INSP. �� r
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
FINAL INSP.1.22
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SPARK ARRESTOR
LAUNDRYTRAY
AIR HANDLING UNIT CFM
MESH
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. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. Ff. RESID ® 11/4 C
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/.c
HOUSE SEWER
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 6 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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICEOrf-FINAL
INSP. �� r
BOND BEAM
WATER SYSTEM
FINAL INSP.1.22
AL INS
GRADING
C / Cu. yd.
$, plus x$
REMARKS:
.
=$
LUMBER GR.
FRAMING
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESlINITIALS
GARDEN WALL FINAL