002884 (SFD)at
P.O. BOX 1504 No. 002884
Building 78-105 �0%8 l C� LA QUINTACCALIFORNIAALLE 92253
DO
Address -
Owner
Mailing
Address. l os ocmroxv city nam
City
Fip9no
Tel. 568-2828
Contractor
_VM mid
Address
Sam
City. Zip Tel.
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description FM S •- PH&CM '14 A
Fri iM
State Lic.
& Classif.
City
Lic. #
MSizeZ•
INC 1334
Sq. Ft. GM -
No. No. Dw.
Stories Units
Arch-, Engr.; '
.. Designer. ..
New q; Add ❑
Alter ❑. Repair ❑ : Demolition ❑
p
Address
Tel.
Side Setback from Property Line
FINAL DATE
City
Zip
State
Lic. #
Validated by:
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.�P>.
Validation:
A 7 2 6 0
2 6 26226 CK
- _SIGNATURE ./ .f DATE
OWNER -BUILDER' DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (.Sec. 7031.5, Business• and Professions Code: Any 'cityor county which requires a
permit 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 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: (Secr•.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 • for; sale.. If, however, the building
or improvement is sold within one year of completion,. the owner -builder will have the burden
of proving (hat he did not build or improve for the purpose of sale.). _. . . . I . '
❑ 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.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Estimated Valuation
%12".'00
.. PERMIT •
AMOUNT .
Plan Chk.`D.ep.
-
Plan Chk. Bal.
p
, W�
..Const.
Mech.
34.00 '
Electrical
59."
Plumbing
'87-50
S.M.I.
'
'6.62
Grading
Driveway Enc.
Date Owner
Infrastructure
1,413.66
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. . ❑ Certified copy is hereby furnished.
•
CERTIFICATE OF EXEMPTION FROM
_ WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is forone 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 any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
TOTAL
2,362,26
REMARKS' .
'
Date Owner
NOTICE TO APPLICANT.- If, after making this Certificate of Exemption ycu 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. ,
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 /r 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 2-4-87 Permit
Validated by:
Validation:
A 7 2 6 0
2 6 26226 CK
CONSTRUCTION ESTIMATE '"
" NO. ELECTRICAL FE�
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
(SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
PDA. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO, FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
U&S (ROUGH) / p9, 7
DRAINAGE PIPING
WALL SQ. FT. p
OTHER APP.IEQUIP.
DRINKING FOUNTAIN
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
f7CtfINAL INSP. z — /�--yj
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING pj�- /,�
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
Li��ROOFINGl�1 CLi y� .� �7
LAUNDRY TRAY
AIR HANDLING UNIT CFM
ff
OA
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
Y THING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSPECTION
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
�ICSETBACK / S FROUND
J
911/1
PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
(SLAB GRADE
(�6OUGH PLUMB. -y�
BONDING
HEATING (ROUGH)
STORAGE TANK
01
FORMS 13, �1
EWER OR SEPTIC $
UGH WIRINGZ/ - [/-•� ,
[
DUCT WORK
ROCK STORAGE
�i/GFOUND. REINF. f1 / (?17
Ol D
U&S (ROUGH) / p9, 7
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
�`CREINF. STEEL �C
V
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
f7CtfINAL INSP. z — /�--yj
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$-Plus-X$-=$
LUMBER GR.
E40INALINSP.6 -/Y-F'7
FRAMING pj�- /,�
4O((6NAL INSP.
KJ
Li��ROOFINGl�1 CLi y� .� �7
0/r! 7 V
r
W �� a, `?, 0 T
5r
ff
OA
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
Y THING
MESH
Lz,INSULATION/SOUND i ei 0 D 7
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL .
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL