04960 (SFD)Zl 0414 a"
I v
P.O. BOX 1504 N Q , 04980
Building 78-105 55-043 Shoal Creak LA QUINTACCAL FORNIA 92253
Address ,
Owner
Sunrise Company BUILDING: TYPE CONST. OCC: GRP.
Mailing _
Address -600 1111n.lik s - o-p—t. tliltA CO A.P. Number 'Pr.A 'Vig rat - Trxrt 2.07.17-1
City Zip Tel. _.
P 1%! 111P 510r s.� _ R Legal Description
Contractor Project Description inti n to n 17A_ 'V l f%n Ci P
Address
City """' Zip Tel. - -
State Lic. City
& Classif. 288130 Lic. # 328 Sq. Ft. 2489 No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address TeL
City Zip State
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 section need not be completed if the Permit is for one hundred dollars (5100) valuation
or less.)
I certify that in the performance of the 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: ff, after makhV this Certificate of Exemplion you should become
subject to' the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this pemrit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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 property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
1 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 laves 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
Loan CrAdit
TOTAL
REMARKS
17
51
AMOUNT
1500.10
610 .50
33.00
113.52
111.00
x'1.44
1,914.84
ZONE:
Lic. #
Minimum Setback
' LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l 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.
_SIGNATURE_Y-`' DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Bustness and Professions Code: Any city or county which requires a
Estimated Valuation
permit to construct, after, krmrove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to fife a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (conenencing 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
PERMIT
Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dc0ars (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, Buisness and
Code: The Contractor's License Law does not apply to an owner of property who
Plan Chk. Bal:
Const.
Mech.
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for safe. ff, however, the building
Electrical
or improvement is sold within one year of completion, the owner -baler wig have the burden
of proving that he did not build or knprove for the purpose of sake.)
Plumbing
❑ 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
S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O I am exempt under Sec_ R, 8 P.C. for this reason
Grading
Driveway Enc.
Date owner
Infrastructure
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 section need not be completed if the Permit is for one hundred dollars (5100) valuation
or less.)
I certify that in the performance of the 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: ff, after makhV this Certificate of Exemplion you should become
subject to' the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this pemrit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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 property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
1 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 laves 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
Loan CrAdit
TOTAL
REMARKS
17
51
AMOUNT
1500.10
610 .50
33.00
113.52
111.00
x'1.44
1,914.84
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/$/88
Issued by:
Date Permit
Validated by:
Validation:
...-I ✓1 _ 0
All. CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
4oT FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE i
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. ®
=$
LUMBER GR.
FINAL INSP.
URINAL
SQ. FT. @
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIREPLACE
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, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
CERT. OCC.
GAS PIPING
PERMIT FEE
PERMIT FEE
n
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 APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE i
GROUT
WATER HEATER
SERVICE 429:
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 INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL