002004 (RR)P.O. BOX 1504
Building 78-435 Creat View LA QUINOTACACALIFORNIA 92253
Address
Owner
rk1h TitlY'f ±r
Address
City
Contractor
Ct MVIr t nf3 c7 +
Address
78-550 DarbY Amid
City 7ip
421
State Lic.
& Classif. 274 421
Arch., Engr.,
No. 002004
BUILDING: TYPE CONST. OCC. GRP..
r
A.P. Number
Tel.
345-^2319 Legal Description
Project Descriptiona-`1 f fiat QSra' ae USS
nw Netal cm edmes.
Tela `
City
Lic. # Sq. Ft. No. No. Dw.
Size Stories Units -
• Designer + -
New Q Add ❑ Alter ❑
Repair ❑ Demolition ❑
t
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:
Address V �� [[ �'
Tel.
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
I hereby affirm thait 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
City
State
JZip.
` This is a building permit when properly filled out, signed and validated, and is subject to
Lic. #
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.
Issued by: Date T-..20 -Flt Permit
LICENSED CONTRA,QTOR'S DECLARATION
T
construction, and hereby authorize representatives -of this city to enter the above-
1 hereby affirm that 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
mentioned property for inspection purposes.
Validated by:
effect .- % !rr�s ..
Signature of applicant / - Date -
-- -
Mailing Address "l
SIGNATURE+ - DATE
City, State, Zip
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
1f()50.00
HARD COPY
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and,
reason: (Sec. 7031.5,Business and Professions code: Any city or county which requires a
permit to construct, alter, improve, or repair- any structure, prior to its issuance also
• requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
_a PERMIT
AMOUNT
the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
.x
Division 3 or the Business and Professions Code, or that. he is exempt therefrom,- and the basis
Plan De
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant /or a permitp
Chk.
subjects the applicant to a civil penalty o/ not more than five hundred dollars ($500).- . '
Plan Chk. Bal.
❑_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
Const.'C
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
Mech.
provided that such Improvements are not intended or offered /or sale. 11, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
Electrical
'
o/ 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
-
does not apply to an owner o/ property who builds or improves thereon, and who contracts for
S.M.I.
.!;n
- such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - -
Grading '
❑ 1 am exempt under Sec. B. ti: P.C. for this reason
_ 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
❑ Copy is filed with the city. , ❑ Certified copy is hereby furnished..
TOTAL
iii �i'1t1�
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS'COMPENSATIONINSURANCE• -
(This section need not be completed it the permit is /or 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.
1 NOTICE TO APPLICANT.,r It, after 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 thait 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 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.
Issued by: Date T-..20 -Flt Permit
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.
Validated by:
�/
Signature of applicant / - Date -
-- -
Mailing Address "l
_
Validation: -
City, State, Zip
'
A 3 8 9 1 1 20 2x00 CK
HARD COPY
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT. Q
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
ROUGH WIRING
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. I SQ. FT.
HEATING (FINAL)
WALL SQ. FT.
REINF. STEEL
DRINKING FOUNTAIN
SQ. FT. (off
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
SERVICE
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FRAMING
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
AFIRE ZONE ROOFING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAR. FIREWALL
GAS PIPING
PERMIT FEE
LATHING
MIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEECONST.
r
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 APP./EQUIP.
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
0.2
/
REMARKS:
VENTILATION
AFIRE 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