10797 (PLBG)P.O. BOX 1504 No. 10797
Building 53--460 Ave Velasco 78-105 CALLE ESTADO ( I -)--
Address LA QUIN IA, CALIFORNIA 92253 J '
Ow
ner
�/Airs William Rogers
Mailing BUILDING: TYPE CONST- OCC: GRP.
Address same.
A.P. Number 774^45-'010
City _Qui.nta Zip 92253 Te
Contractor
L. L. Milson Construction
.Address
P. 0. Box 1687
Description
Project Description
Sesser Hook tip
Crc�y.ndi.o
Z'p9220i
Tel
-
State Lic.
City
& Classif. 529319
Lic. #
Sq. Ft.
No. No. Dw.
'
Size
Stories Units
' Arch., Engr.; •
-
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
-
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I 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
effect. ] (. �. r i � ' 16
SIGNATURE - DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
_
I hereby affirm that I am exempt from the Contractor's License Law for the following
1 700
reason: .(Sec...7031.5,Business and Professions Code: Any city, or county which -requires a
permit to construct, atter, improve, demolish, or repair any structure, prior to Its issuance -also
-
;
requires the applicant for such permit to Re'a.signed statement that he is licensed pursuant to
PERMIT
AMOUNT -
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 Any Section 7031.5 by 'any for
Plan Chk. Dep.
- -
alleged exemption. violation of applicant a permit .
' subjects the applicant to a civil penalty of not more than five hundred dollars.($500).
Plan Chk. Bal.
,
O 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
COrtst.y^ ^
Professions Code: The Contractor's License Law does not, apply to an owner of property who
builds or improves thereon and who does suck* work himself or through his own employees,
- Mech. �'� -
provided that such improvements are not intended or.oNered for sale. If, however, the building-
or Improvement is sold within one year of completion, the owner -bulkier will have the burden
Electrical
of proving that he did not,budd or improve for the purpose of sale.)
_
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
30.00
struct the project. (Seca 7044, Business and Professions Code: The Contractor's License Law
does notapply to an owner of property -who•builds or improves thereon, and who -contracts for
S.M,I,
-
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. B. & 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
.0 Copy is filed with the.city. ❑ Certified copy is hereby furnished.
TOTAL
30.00
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 anyperson in any manner so as to become subject to the Workers' Compensation
Laws of California
Date 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
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.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it 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 inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
.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
Issued by: Date Permit
Validated by:
Validat
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL SO. FT.
POR. . SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT.
SO 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 V c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3Vac
HOUSE SEWER
FINAL INSP.
ROOFING
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
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER Qfi1=fifi2T4Q-f*NK
OUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTIONS/
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
,
GARDEN WALL FINAL