003009 (BLCK)C cv
P.O. BOX 1504
Building 78-105 LA QUINTACCALIFORNIA92253
Address 7���'fi-� L`33llL '�'F�p�:Co ,. , ....
Owner
mailing
Address 521 24th Street
City' Zip 1,213--r451-5277
el.
. Sc� ata Monica .. 90402.
Contractor NWS
. .. . LYl S Ind..
Address .. .. _-
6946 Stan Y$ Blvd.
City Zip - Tela
No.. 003009
BUILDING: TYPE CONST. OCC: GRP. .
A.P. Number 769--830-035 '
Legal Description
Project Description Block :.11
Van suvin
91405
.818-995-49S
ZONE:”
State Lic.
& Classif.. 4154561
City
Lic. # 907
Sq. F1_ 178U
Size" *
ft No. No. Dw.
StoriesUnits
Arch., Engr., _ .
Designer
New E19 Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
Side Setback from Property Line
City
Zip
State
Lic. #
Date Permit
Validated by:
LICENSED, CONTRACTOR'S DECLARATION
*f I hereby affirm that I amlicensed under provisions of Chapter9 (commencing with Section
75.-7000) of Division 3 of the„Business and Professions Code, and my license is in full force and
effect.
Validation:
_
87605
SIGNATURE f DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors License Law for the following
. reason: (Sec..7031.5,Susiness 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
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
subjects the'app/icant to a civil penaffy of not more than rive hundred dollars'($500).
O 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. (Seca 7044, Bufsness and
Professions Code: The Contractor's License Law does not apply dan owner of property who •.
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements ar6L not intended or offered for sale. If, however,. -the building
or improvement 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 sale.) ,
• ❑ I, as owner of the property, am exclusively contracting with licensed contractors 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 builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)' -
0 I am.exempt under Sec. B. & P.C. for -this reason
Estimated Valuation
PERMIT
- -
AMOUNT
:r
Plan.Chk.. Dep.
_
Plan Chk.' Bal.
. COrt5t
P.
Mech.
Electrical
-
Plumbing
- S.M.I.
-
Grading
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
O Copy is filed with°the city: .O Certified copy is hereby furnished. /
f ? . t/
s: r r { f !f �,. �! [�i!.Gs c•.firr i �;
• I 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.) ... _ .-
TOTAL
i f, -A in
REMARKS.
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.
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 if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is'correct.'•_=
A agree to comply with all city and county ordinances and state laws ielating to building
construction, and hereby authorize representatives -of this city to enter the 'above-.
mentioned property for inspection purposes.
Signature of applicant -Date-
Mailing
ate Mailing Address
City, State, Zip
HARD COPY
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:
Validation:
87605
3 63.16 fl
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES ,
IST FL. SQ. FT. g $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ, FT. ®
CAR P. SQ. FT.
WALL SO. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
r
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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
'
l^L�L�WW
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/
SQ.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
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
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
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
'
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�—
�! All
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL