04954 (SFD)174
2_4 T4t!t 4
Building 54-454 Shoal Creek
Owner
Address
City
Address.
iogal Marteane
Zip Tel.
P.O. BOX 1504
78-105 CALLE ESTADO
IUINTA, CALIFORNIA 92253
No. 04954.
BUILDING: TYPE CONST. OCC: GRP.
elm I 1>g% 9.,%A A.P. Number RCA, Hast .... "Prswet 90717-1
56 '28,28 Legal Description
Project Description Phase 17A Plan 4C
State Lic. (City
Class if- 2118130 Lic. # 32
Arch., Engr.,
Designer
Address Tel.
City I Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby m.t
affirhat 1 am licensed under provisions of Chapter (commencing,with Section
e001n of Division 3 of the Business and Professions•Code, and my license is in'full force, and
ffect. 'r
SIGNATURE _ DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,8usiness and Professions Code: Any cry or county which requires a
permit to construct. alter, Improve, demofsh, or repair any structure. prior to its issuance also
requires the applicant for such permit to Me a signed statement that he is licensed pursuant to
the provigons of the Contractor's License Law, Chapter 9 (comcenobg with Section 7000) of
Lkvisbn 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 applicant to a civil penalty of not more than five hundred dollars ($500).
❑. 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
Professions Code. The Contractors License Law does not appy to an owner of property who
Lwtds or Improves thereon and who does such work himself or through his own employees,
provided flat such. improvements are not Idended or offered for safe. t1, however, the building
or improvement is sold within one year of completion, the owner-6m7der will have the burden
of provlrg thathe dad not build or rrprove for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec. 7044, Busuhess and Protessions Code: The Contractors License Law
does not appy to an owner of property who bulls or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractors License Law.) .
❑ 1 am exempt under Sec_ R_ g P.C. for this reason
Date Owner
WORKERS COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers 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' COMPENSATION INSURANCE
(This sermon need not be completed if the permits 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 California
Date Owner
NOTICE TO APPLfCANT: ff, after making this Certificate of Exemption you should become
su4fect to the Workers' Conpensaton provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shat be deemed revoked.
CONSTRUCTION LENDING AGENCY
1hereby 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
Lenders Address
This is abuilding permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days- "
I certity 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 orf this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Sq. Ft. 1918 No. No. Dw.
Size Stories Units ,
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
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
Estimated Valuation
�1�2 Ila
INSPECTOR
PERMIT
12 / 8 /'18Permit
AMOUNT
Plan Chk. Dep.
Validated by:
i
Plan Chk. Bal.
Validation:
$ 442.73
Const.
515.30
Mech.
34.00
Electrical
74 . 6!5f
Plumbing
87.5C-
7.5CS.M.I.
S.M.I.
Grading
Driveway Enc.
Infrastructure
$2,988.36
1,494.la,
tpna Credit
L424o18
TOTAL
REMARKS
XV ,torr x
f!rfrtL. a ::!� sc�v
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 / 8 /'18Permit
Issued by:
Date
Validated by:
i
Validation:
.-1 .✓L - '7
i
GROUND PLUMBING
UNDERGROUND
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
HEATING (ROUGH)
STORAGE TANK
FORMS
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. @
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
GROUT
WATER HEATER
E
FINAL INSP.
DRAINAGE PIPING
CAR P. SQ. FT. ®
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
DRINKING FOUNTAIN
WALL SQ. FT. ®
FINAL INSP.
FRAMING
FINAL INSP.
URINAL
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
VENTILATION
FLOOR DRAIN
MECHANICAL FEES
FIRE ZONE ROOFING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
VVASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Va c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
FENCE FINAL
ING
PERMIT FEE
PERMIT FEE
FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEEI
EPERMIT
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
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
T!7. POLE
GROUT
WATER HEATER
E
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
F ISH GRADING
INAL INSPECTION i
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
1