07206 (BLCK)4
P.O. BOX 1504 No.
Building LA gUINTACCALIFORNIA 92253
Address �3•7S9 .iiTaL@8 _
Owner
Mailing
Address
City Zip Tel.,,. -
Contractor
Address
51-14DS Rami�r.
-City Zip Tel.-
La
elaLa pinta 92253 -564-311.5._
State Lic. City:
& Classif. 382205 Lic. # 1407
Arch:, Engr.,
"Designer
Address I Tel.
City I
Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under Provisions of Chapter 9 (commencing with Section
7000) of Division $'of the Business and Professions Code, and my license is in full force and
effect
_SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affign that 1 am exempt from the Contractors License Law for the following
reason: (Sec. 7031-5,Bushess and Professions Code: Any city or county which requires a
Permit to construct, alter, irprove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to Me a signed statement that he is licensed pursuant to -
the provisbna of the Contractors License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Cade, 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 ciW penalty of not more than live hundred dollars ($500).
❑ 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, 8uisness and
Professions Code: The C wthador's License Law does not apply to an owner of property who
builds orrrproves thereon and who does such work himself or through his own employees,
provided that such krprovements are not intended or offered for sale. lf, however, the building
or improvement is sold within one year of completion, the owner -budder will have the burden
of proving that he did not bold or krprove for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec. 7044, Busness and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or inproves thereon, and who contracts for
such projects with a conmactor(s) licensed 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. ❑ Certified copy is hereby fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California
Date owner
NOTICE TO APPLICANT: ll, after making Oris Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or Oris pemtit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec.. 3097, C" Code.)
Lenders Name
Lenders Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certity that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives .of this city to enter the above-.
mentioned property for inspection purposes
Signature of applicant Date
Mailing Address
City,- State, Tap
07206
BUILDING: TYPE CONST. OCC: GRP.
A.P..Number 774-151--001
Legal Description
Project Description 2p X 154' Retaining vaU
Sq. Ft. No. No. Dw.
Size Stories - -:- Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
stimated Valuation
Sli$Q�
PERMIT
AMOUNT
Plan Chk. Dep.
`ems
Plan Chk. Bal.
% S.
Const.
Mech.
/
Electrical
! 1
Plumbing
Validated by:
S.M.I.
Grading
t
Driveway Enc.
e
Infrastructure
f
f
r
TOTAL
REMARKS
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
I SPECTOR
2%23/90
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN.,
SQ FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
_$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING =
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.
SO. FT. @ c
BATH TUB
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
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 & 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
REMARKS:
VENTILATION
FIRE ZONE ROOFING =
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL, INSPECTION- '
CERT. OCC..
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL