002880 (BLCK)P.O.BCX1504 No. .002880
Building 53-795 emi,& Juarez LA QUIN
Address Tt:1A, CALIFORNIA 92253
Owner _ ...
ralum A. x qft
Mailing BJILD4NG: TYPE CONST. OCC: GRP.
Address ' A P. Number 774-143- 015
CityZip ITel.
� } . LBgal Description %7t 3
Contractor. Project Description
X�!
,. Address . .. ". .. -
a e 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
Ihereby 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 if 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 i1n'specti�onypurposes.
Signature of applicant • V!•--.. - Yr <0 Date
Mailing Address
City, State, Zip
HARD COPY
ZONE:
BY:
Minimum Setback. Distances:
City
Zip
Tela
Rear Setback from Rear Prop. Line
State Lic.
& Classif.
City
Lic. #
Sq. Ft. No.
Size - 100. 1$M- ft•StorieS
No. Dw.
Units
Arch., Engr., '
Designer
New Add ❑ Alter ❑
Repair ❑ Demolition ❑
Address
Tel.
City
. . 1.
Zip
State
Lic.•#
3-1bot highr+��j,
Y,> ll
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I em licensed under provisions of Chapter g (commencing with Section
7000) of Division 3 of the Business and Professions Code, and mylicense is in full force and '
effect..lY
_
SIGNATIIRF7 DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a
Permit to construct, after, 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 that. he 7s exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 .Gy "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 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 o/ 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
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.
%strucl 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 /or •
such projects with a -contractors) licensed pursuant to the Contractor's License Law.) -
❑ I am exempt under Sec.. B. 8 P.C. for this reason
Estimated Valuation
3 •��
PERMIT
AMOUNT
-
Plan Chk..Dep.
-
-
Plan Chk. Bal.
17.22
Const.
25...
Mech.
Electrical
Plumbing -
S.M•1•
Grading
Driveway Enc.
Date Owner 'y-CL-anremfrs',
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. (Seca 3800, Labor Code.)
Policy No. .Company
❑ 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 tha 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.
Dt
TOTAL
44.22
REMARKS
-
_
c
a e 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
Ihereby 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 if 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 i1n'specti�onypurposes.
Signature of applicant • V!•--.. - Yr <0 Date
Mailing Address
City, State, Zip
HARD COPY
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 2-3-87 Permit
Validated by:
Validation:
A 7 2 3 2
2. 3 44.22 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ, FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ, FT. ®
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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
_[__MICRO
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
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
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
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