002897 (SFD)P.O. BOX 1504. NQ, 002897
Building55-134 � �t LA QUINOTAC
Address CALIFORNIA 92253
Owner
ftrim`ty BUILDING: TYPE CONST. OCC: GRP.',
Mailing
Address it3—M C11*11 Rive A.P. Number
CityZip Tel.
FWn .�. 9.2260J . W_2ng
Legal Description
ContractorProject Description Pt $ AW2 14 .A
final Mrtgage and Lwd
Address .. PLAN 4.'s�R.
City . Zip Tela
State Lic.
City
1918
& Classif.
Z 3
Lic. #
S Ft- ` +�C
Size..
No. No. Dw.
.... Stories Units
Arch.- Engr.-.
Designer
New lel: Add ❑
Alter ❑. Repair ❑ Demolition ❑
Address
TeL
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I atn,lrcensed under provisions of Chapter (commencing with Section
7000) of
effect.Division,/3 of the`Business and.Professions.C,ode, and my license is in full force and/
SIGNATURE 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 city or 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 rile 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 civilpenaltyof not more than rive hundred dollars-(3500)."�:
O I, as owner of the property, or myemployees 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
Estimated Valuatl0n
$ 332,916.00 "
-
PERMIT
-
AMOUNT
Plan Chk. Dep...
Plan Chk. Bal..
iw^
442 73
Const. ,
s50
Mech.
.
�A
.fJW
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
Electrical -
74.69*of
or improvement is sold within one year of completion, the. owner -builder will have* the burden
proving that he did not build or improve for the purpose of sale.) ,
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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law:)
0 1 am exempt under Sec. B. & P.C. for this reason
S.M.I:-
_ -
-9.28
Grading
Driveway Enc.
Date owner
Infrastructure
1.992,24
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. -0 Certified copy is hereby furnished'.
TOTAL
3,155.94
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.) - -
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.
r
' Date Ownei"
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
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
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.)
Side Setback from Property Line
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. pi
Signature of applicant _ r7 '! % Date ! y
Mailing Address / �`
FINAL. DATE '
Issued by:
Validated by:
Validation:
A 7 2 6 2
INSPECTOR
Date 2--4-07 Permit
2 6 594 fti
City, State, Zip i
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FFAI11k
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT.
ROUGH PLUMBC/- l,��'
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT, ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT. ®
2a4S (ROUGH) S C_G-7
J
DRINKING FOUNTAIN
SQ. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
plus x$ _$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
fU-/FRAMING Gl �I _ �`�
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/a C
SEWAGE DISPOSAL
MESH
SO.FT.GAR ® 3/aC
HOUSE SEWER
A4NSULATION/SOUND
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
94zSETBACK,;t-/? --g-
ROUND PLUM BINCbj �y��
UNDERGROUND
A.C. UNIT
COLL. AREA
J /SLAB GRADE 3-L'j_'
ROUGH PLUMBC/- l,��'
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS ,. / ,c
WER OR SETC 1f�VKG
UGH WIRING/ice 7 /-� )
`l O`
DUCT WORK
ROCK STORAGE
��FOUND. REINF. -( 3X77
2a4S (ROUGH) S C_G-7
J
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
(,OEINF. STEEL 7 �
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
F AL INSP/
goo
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$ _$
LUMBER GR,
A INAL INSP. /l l
�o
fU-/FRAMING Gl �I _ �`�
FINAL INSP.
Ke,'ROOFINGF L/ � 7 � 0 �
// 0
Q �L rO (/1i
a
LoY
�p
A/iA
REMARKS:
TION
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING C� a� -j-'
MESH
A4NSULATION/SOUND
FINISH GRADING
01Y INAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL