002746 (ELEC)P.O. BOX 1504 No. 002746
Building 78-105 78,-178 Crile � LA QUINTAC
Address CALIFORNIA 92253
Owner tom,.,
R�LeY BUILDING: TYPE CONST. OCC: GRP.
Mailing .
Address
A.P. Number
City Zip Tel.
Tie: OArta 9225 Legal Description
Contractor Project Description
Address
74-943 FhAxwfty Drive
City Zip Tel.
laOubitra 92UO 345-3548
State Lic. City
& Classif. � Lic. #� Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New EIC Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel. Pemit for m1w. elect.xim . Vm Briar
City Zip State��
Lic. #
LICENSED CONTRACTOR'S DECLARATION L
I he affirm that I am licensed under po" isions of Chapter 9 (commencing with Section '
7000) of DiGision 3 of the Business and Prdfe sions Code, and rliy license is in full force and -
effect. _ {'"
., t a_ ��o
ZONE:
SIGNATURE Y. `✓y'e -`+ice{ °•' • "'" �' DATE
subject to the Workers' Compensation provisions of the 'Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. -
' OWNER -BUILDER DECLARATION
Estimated Valuation
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
'
CONSTRUCTION LENDING AGENCY
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 licensedpursuant to
PERMIT -
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
Plan Chk. Dep.
subjects the applicant to a civil penalty oFnot more than fivehundreddollars ($500).
Lender's Name
0 I, as owner of the property, or my employees with wages as their sole compensation, will _
Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
Code: The Contractor's License Law does not apply to an owner of. property who
This is a building 'when properly filled out, signed and validated, and is subject to
builds or improves theieon and who does such work himself or through his own employees,
Mech. .
provided that such improvements are not -intended or offered for sale. If, however, the building
I certify.that I have read this application and state that the above information is, correct.
or improvement is sold within one year of completion, the owner -builder will have•the burden
Electrical
of proving that he did not build or improve for the purpose of sale.) '
_
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
struct the project. (Sec. 7044, Business and Professions Code: -The Contractor's License Law
S.M-,I,
does not apply to an owner of property who builds or improves thereon, and who contracts for
-such projects with a contractor(s) licensed pursuani'to the Contractor's License Law.)
9
Grading
O I am exempt under Sec. - B. 8 P.C. for this reason .
Validation:
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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. 0. 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.
_D
Driveway Enc.
Infrastructure
TOTAL
� �tlils EY�
AMOUNT
REMARKS .
ate Owner
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions of the 'Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. -
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 'when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.�L^�AV
c
12-5-86
I certify.that I have read this application and state that the above information is, correct.
Issued by:
Date permit
I agree to comply with all city,and county ordinances and state laws 'relating to building
_
construction, and hereby authorize representativesf`-of
mentioned property for in�s6ection purposes�`.I� �I f
4^ 1f♦/!sF-ate
this city t& enter the above-.
j1
6
Validated by:
Signature of applicant V =^ �1 w
9
Mailing Address �r—s 'r
Validation:
City, State, Zip
A 6 8 6 9
12 5 2Q00 CK
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST 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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
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.
SO. FT. ®c
BATH TUB
FRAMING
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
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
ERGROUND 2
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
H WIRING
*METER
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING
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