002885 (SFD)P.O. BOX 1504
Building556 i � LA QUINOTAC
Address CALIFORNIA 92253
Owner.
>
No. 002885
Mailing
BUILDING: TYPE CONST. OCC: GRP.
Address75_005 ():3� �,
A.P. Number
CityZip
Tel.
a_?�
_ Z
Legal Description
Project Description
POM -14 A
Contractor
and LandA
pim Im'
Address
sam
City.
$0W_
Zip.
'Tel.-.
State Lic.
City
EKC. 1330
& Classif.
Lic. #�
Sq. Ft. Gm -424
Size. •
No. No. Dw.
Stories . Units
Arch.; Engr.; -
Designer
New 13it Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
t
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 forcb and/
effect.
_
SIGNATIJRE DATE
a
OWNER6BUILDER DECLARATION ''
I hereby affirm that I am exempt from the contractor's License Law for the followingGs2�IIV��
reason: (Sec. 7031.5,Business and Professions rCode: Any aly .or county:which requires
s-a
peimit to construct, alter, 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 Busihess *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).• . :._ '•
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. (Sec. 7044, Buisness and
• Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself.or through his own employees,-
provided that', such_ improvements are not intended or offered to,, sale. If, however, the building
Estimated Valuation
A Aa�
,
PERMIT
AMOUNT
•Plan Chk. Dep.
-
'
Plan .Chk. Bal.
342.49
COnSt.
a00 ,
Mech,.
34...0
Electrical
59 99
or improvement is sold within one year of completion, the owner-builder.w81'have the burden
of proving that he did not build or improve for the purpose of sale.)
Plumbing
87.50
0 1, 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:)
. ❑ I am exempt under Sec. B. 8 P.C. for this reason -
S.M.I.
- 6.62
Grading
Driveway Enc.
Dale owner
Infrastructure,����s
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
❑ Copy is filed with the city. . O Certified copy is hereby furnished. .
TOTAL
2,362.26
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed if the permit is for one -hundred dollars ($100) valuation
. .or less.) _ _ -
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 -.o the Workers' Compensation
Laws of California.
-
'Date Owner
NOTICE TO APPLICANT., ll, after making this Certificate. of Exemption you.should become
' subject to the' Workers' Compensation provisions of theLabor Code,- you must forthwith
comply with such provisions or this permit shall be deemed revoked. -
ZONE: BY:
Minimum Setback Distances:
Front Setback.from Center.Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback.from Center Line
hereby affirm that there is a construction Iending'agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Side Setback from Property Line.
Lender's Name
FINAL DATE
Issued by-
Validated by:
Validation:
A7259
INSPECTOR
Date -2—A-87 Permit
2 6 236226 CK
Lender's Address
This is a building permit when, properly'fiIled 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..
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. // I
Signature of applicant - ` Dale.•��
Mailing Address
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE \
NO. ELECTRICAL EFAdbk
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $�
UNITS
COLL. AREA
2ND FL.SQ. FT. @
,ROUGH PLUMB 11-17
YARD SPKLR SYSTEM
POR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SQ, FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
rli�S (ROUGH) 5_ _(+J�
QA
6
DRINKING FOUNTAIN
SO. FT. @
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GGAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ plus x$ =$
LAUNDRYTRAY
AIR HANDLING UNIT CFM
LleeINAL INSP.G, ��,
IKITCHEN 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/a c
SEWAGE DISPOSAL
''//GAR.
CAfIATHING
SO.FT.GAR @ 3/ac
HOUSE SEWER
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
1((6SETBACK �� / _
ROUND PLUMBINGa -(��
UNDERGROUND
A.C. UNIT
COLL. AREA
►L(e SLAB GRADE �Q �
,ROUGH PLUMB 11-17
BONDING
HEATING (ROUGH)
STORAGE TANK
)(� FORMS
'SEWER OR SEPT
WIRING
(
DUCT WORK
ROCK STORAGE
;L4FOUND. REINF. 3 �a _ C
0
rli�S (ROUGH) 5_ _(+J�
QA
6
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GGAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICEFINAL
INSFt ,_ ^S
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$ =$
LUMBER GR.
LleeINAL INSP.G, ��,
210RAMING L/—��/ 4
FINAL INSP. %f—/5-5—?
ROOFINGor-� / / / ^ �—C ?
`!` `i 71
C /<- 'T� f�tJ l L /jvo (p (
Pop l/I L Ali • 1 G
` I ` /�/
S' S" 9 / OYl
'
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
FIREWALL
''//GAR.
CAfIATHING
MESH
��INSULATION/SOUND !iJ
r
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL