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05068 (SATT)3keT4ht u�,tcv P.O. BOX 1504 BuildinAddrress 54-� 388 Tangiecaa©d LA QUINTACCALIFORNIA 92253 sunrise Connauv Address 42-600 Cook St... Suite �! City lZip ITel. i— Contractor Address City "' ""' Zip Tel.- . Sq. ft. Size... 2489. ' State Lic. City & Classif. Lic. # t Arch., Engr., Designers Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION 1 herebv affirm that I am licensed under. provisions of Chapter 9 (commencing with Section 7000) 11 Division 3 of the Business and Professions Code and my license is in full force and ef(ecL r DATE OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the` following teasom (Sec. 7031.5.8usiness 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 Me provisions of the Contractor's License Law, Chapter -9 (commencing with Section 7000) of Divi9on 3 of the Business and Professions Code, or Mat. he is exempt therefrom, and the basis for the ateged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than rive hundred dollars (5500). ❑ 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, Bufsness and Professions Code: ,The Corit aciot s License Law does not apply to an owner of properly who dads or improves thereon, and' who does such work herself or through his own employees, Provided Mat' such errproverrients-.are not intended or offered for sate. ff, however, the building g or irprovement 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 safe.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to cors• struct the project (Sec. 7044, Business and Professions Code. The Contractor's License Law does not apply to an owner of property who dills s or krproves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to tire Contractor's License Law.) ❑ 1 am exempt under Sec B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 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. CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (Iles section need not be completed if 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 Cali omia J Date ( 1 Owner �E M017CE TO APPLICANT: ff. after mak g this,CerVicata 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 shaft be deemed revoked. CONSTRUCTION LENDING AGENCY 1 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.) 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 car tity 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, Zip No. 05068 BUILDING: TYPE CONST. - OCC: GRP. A.P. Number IYGA Went P1tAse 31A Legal Description Project Description. P1.mn 9C 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 INSPECTOR 12/27/88 Issued by: Date Permit Validated by: Validation: Sq. ft. Size... 2489. No. Stories No. Dw. Units _ New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $170,208 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 500.90 Const. 610.50 Mech. 33.00 Electrical 113.52 Plumbing 111.00 S.M.I. 11.94 Grading Driveway Enc. Infrastructure $3,829.68 1.,914.84 Lees Credit 1,914.84 1$3,295.70 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 INSPECTOR 12/27/88 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS LAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SO. FT. FORMS ER OR SE 6/9 '71 97 ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SO. FT. ® GA (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR. SO. FT. ® TE . POLE GROUT DRAINAGE PIPING CAR P. SO. FT. ® FINAL INSP. BOND BEAM WATER SYS7rM DRINKING FOUNTAIN WALL SO. FT. ® =$ LUMBER GR. FINAL INSP. WF R_AM ING 7 URINAL SO FT ® / ESTIMATED CONSTRUCTION VALUATION $ REMARKS: WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED SPARK ARRESTOR LAUNDRY TRAY AIR HANDLING UNIT CFM G . FIREWALL ING 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 @ 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ec HOUSE SEWER FENCE FINAL 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 SBACK OUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA LAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS ER OR SE 6/9 '71 97 ROUGH WIRING DUCT WORK ROCK STORAGE 1 OLIND. REINF. GA (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL (FINAL) / TE . POLE GROUT WATER HEATE RVICE FINAL INSP. BOND BEAM WATER SYS7rM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. WF R_AM ING 7 FINAL INSP. OOFING / � REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR G . FIREWALL ING MESH *-NIULATIONISOUND FINISH GRADING L INSPECTION / t �r CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESJINITIALS GARDEN WALL FINAL