003556 (BLCK)Building
Address
Mailing
Address
City
Con
44
P.O. BOX 1504 No.
�6
53--460 Juarez LA QUINOTACt
CAL FORNIA 92253
Rack Johnson CousGruction BUILDING: TYPE CONST. , OCC: GRP.
Zip
Zip
A.P. Number 1374-071-011
el.
Legal Description
Project Description s .;,w i f7b X ! r
long - block wall (retaining)
State Lic.
& Classif.
City
Lic. #
Sq. Ft.
Size -
No. No. Dw.
Stories Units
Arch., Engr., •• '. •-•
Designer
New ❑ Add ❑
Alter D. Repair ❑. Demolition ❑
Address
Tel.
CityZip
'
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirmahat 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: (Swec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or 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) of
' 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 for a permit
subjects the applicant to a civil penaHy,of not more than five 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 Contractor's License Law does not apply to an owner of property who+c";
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
of proving, that he did not build or improve for the purpose of sale.) '
❑ 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 contractors) licensed pursuant to the Contractor's License Law.)Rrl-
❑ I am exempt under Sec. B. & P.C. for -this reason
Estimated Valuation
1t A
2$1 6 V'
PERMIT
. -
..
AMOUNT -
Plan Chk.:Dep.
<�2
Plan Chk. Bal.
'
Const.
Mech.
Electrical '
Plumbing
S•M•I, -
Grading
'
Driveway Enc.
Date owner
Infrastructure
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.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
orless.) - - - -
I certify that in the performance of the work for which this permit is issued, I shall not.
employ any peon in any mariner so as to become subject to the Workers' Compensation
Laws of Californirsn
a.
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.
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's Address
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-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, Slate, zip
REMAR
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 1/7/8 Permit
Validated by:
Validation:
HARD COPY -
T _. _.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMB.�G FEES +a
IST FL. SQ. FT. ® $
2ND FL. SO. FT.®
POR. SQ. FT. ®
GAR. SQ. FT. p
CAR P. Q. FT.
WALL SQ. FT. ®
SQ. FT. 0
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE' DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
`BON BEAM Z
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ae
HOUSE SEWER
FRAMING
FINAL INSP.
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 8 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
GR T
WATER HEATER
SERVICE
FINAL INSP.
`BON BEAM Z
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
i
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