04538 (BLCK)Building
4 4 Q _..
P.O. BOX 1504
53-960 Cortez LA QUINTACCALIFORNIA 92253
D. Hoff an
City I Zip ITel. -
Cal. rest Construction
74-990 Valie Way
City Zip Tel.
Palm Dasiott 92260 340�,-80
State Lic. City
& Ciassif. 358730, Lic. p Du
Arch., Engr.,
Designer
Address Tel.
City IZip I LStae
Iate
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
t7000) of Division 3 of the Business and Professions Code, and my license islin full force and
effec.
'SIGNATURE - DATE
OWNER -BUILDER DECLARATION
I -Hereby efflryrl that I am,exempt from the Contrectore License Law for the following
te6son:' (See:. 7031.5,8irs/nesa end Profesa/ona Gbde:, Any city or county wNch roWhes e
peirnk' tC eonsfrieet: akar. 6nprove,. demo/dh, or repair any stnreture, Pnorro its lasuanrw abo
'repu/res the apptkant. for sucA.Pennit ro file a signed statement that he is scaleed pursuant to
I
e 'provlakne Of tAe Contractor's License Law, CAapter 8 (corrunenc6rg wfih Beckon 7000) of
Qivlslon 9.01 the BuaMesa and ProleSskura Cods, of that. he 18 exempt thevefrarrr; and tire basis
fw.the akeged exemption. Any violation of Section 7091.5 by any wpm=# for a permit
subjects the appkcant to a civil penalty of not more. Man five hundred dollars (8500).
d 1, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is notdntended or offered for sale. (Sec. 7044, Submess and
Professions Code: The Contractor's License Law does not apply to .an "owner of property who,
bukds of Improves thereon and who does such work himself or throrgh his own employees;
-provided that such Improvements are not intended or offered for sale. k, however, the bukdkp
or improvement is sold within one year of completion, the owner -builder wN have Me burden
of proving that,he diol not bukd or improve for the purpose of sale.)
❑ I, as owner of the, property, am exclusively contracting with licensedcontractors 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 bu1Ms or krrproves thereon, a -d wAo contracts for
such. projects iktha contractor(a) Ikensed pursuant to the Canhaotor'e License Law.)
❑ I am exempt under Sec. B. 8 P.Q,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. 9800, Labor Code.)
Policy No Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATIONINSURANCE
(ThiasseSection need not be completed If the permit Is for one hundred dokars ($100) vatalum
1 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.
Date -owner
NOTICE -TO APPLICANT: ff, akar making this Certificate, of Exemption you should became
-subject to the ttarkere' Compensation provisions of the Labor' Code, you must forthwim
eomp/y with Such Provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirrn.that there is a.construction lending agency for the perforrnanca of the
work fonwhich this permit Is issued. (Sec. 9097, Civic Code.)
Lenders Name
Lenders Address This Is is a building•.permit:whempropeAy filled out, signed and validated, and Is subject to
expiration If work thereunder le suspended for 180 days.
I certify that I ,have read,thls 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 abortr
mentioned property for Inspection purposes.
Signature of applicant Date
Maillrig. Address
City, State, ZIp
WHITE - FINANCE, PINK.- APPLICANT,,41REEN - SUILI
ILDING: TYPE CONST.,OCC. GRP.
'.Number 7747:142—nth '
Description
.t Description Retaining Wall
Sq. Ft.
Size
No.
No. Dw.
6i
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
$3#750
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mach..
Electrical
Plumbing
S.M.I.
Grading
Driveway'.Enc.
Infrastructure
hl41
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,_ ?N - FTR
Issued by: Date % �/ Permit
Validated by:
Validation:
r.AiSESSOR'S OFFICE,.HARD COPY, -`FILE
CONSTRUCTION ESTIMATL
NO. ELECTRICAL FEES
N.O. PLUMBING FEES
IST FL SO FT (g 3
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
SPKLR SYSTEM
2ND FL SO FT. aYARD
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT M
GAS (ROUGH)
METERILOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT, M
TEMP. POLE
SO
GROUT
DRAINAGE PIPING
CARP FT Q
FINAL INSP.
WALL ScFT a
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
yd.
t plus xi
=t
URINAL
SO. FT. at
FINAL INSP.cu.
FRAMING
ESTIMATED CONSTRUCTION VALUATION t
WATER PIPING
NOTE Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTONDISHI
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SO. FT. RESID a t V. c
SEWAGE DISPOSAL
SO.FT.GAR C Sac
HOUSE SEWER
FINAL INSPECTION C7—
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE EK
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING '& AIR GOND. 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)
METERILOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF..STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM —` l`
WATER SYSTEM
GRADING
yd.
t plus xi
=t
LUMBER GR.
FINAL INSP.cu.
FRAMING
FINAL INSP.
ROOFING
REMARKS;-
EMARKS:VENTILATION
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR -
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION C7—
CERT. OCC,
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIAlS
GARDEN WALL FINAL