002909 (SFD)44
P.O. BOX 1504 N.Q.. 002909
Building 55-269 l c LA QUINOTAC
Address CALIFORNIA 92253
Owner y. .
Address 75-05 0=fti Mub. DriVe
City Zip Tel.
92266 568-2828
.IContractor
Address .
City _ Zip Tel:.
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description FM BE= PMM 15 A
P 3'C'
State Lic.
City
= 1627
& Classif..
Lic. # 328
S Ft. No. No. Dw.
Sze .. Stories Units
Arch., Engr:,
Designer
New CR Add ❑ Alter ❑ Repair ❑ Demolition 0 -
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION.
I hereby affirm that I anj licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the'Busmess and Professions Code, and my license is in-full.force'andd
effect.
("
SIGNATURE - ', i +/ DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Con`tractor's License Law for the following
.
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which•requires a
'
�'���
.
permin to consiruct, alter,7impiove, 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
PERMIT AMOUNT
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 therah-om, and the'basis
• for the Any Section 7031.5. by 'any* for
Plan Chk. Dep.
alleged exemption. violation of applicant a permit
" subjects the applicant to a civil penalty of not more than five hundred dollars ($500):.
Plan Chk. Bal.
_ O I, as owner -of the property, or my employees with wages as theirsole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
. Const.
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,
Mech.-
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 wig have the burden .
Electrical Al
. of proving that he did not. build or improve for the purpose of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing A7_"
struct theproject., (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. R• I{ '
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑.I am exempt under Sec.� B. & P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
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.
TOTAL 2 _7.51 _ 21
_REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE -
(This section need not be completed if the permit is for one hundred dolls; s ($100) valuation
or less.) -
II certify that in the performance of tho work for which this permit is issued, I shall not
anyperson in any manner so as to become subject to the Workers" Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become
ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
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
FINAL DATE INSPECTOR
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.
Issued by: Date 2—A-E7Permit
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. 1, , �
r
A
r7 Validated by:
Signature of applicant- 7 Date ` %
Mailing Address r / % /
Validation:
City, State, Zip ' t
"
A7287 210 i75L21 CK
HARD COPY
s44
CONSTRUCTION ESTIMATEANIL
NO. ELECTRICAL FEF
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
2ND FL. SQ. FT.
POR. SQ. FT. @
GAR. SQ, FT, @
CAR P. SQ. FT. @
WALL SQ. FT. @
SQ FT @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS 3 /2�
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
�-fi'AS (ROUGH) �5 �Y
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
INSP.
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/4 cSEWAGE
DISPOSAL
REMARKS:
SQ.FT.GAR @ 3/4cAELECT.FEE
HOUSE SEWER
FIRE ZONE ROOFING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
y SETBACK ` -12-
OUND PLUMBI G '1
UNDERGROUND
A.C. UNIT
COLL. AREA
"SLAB GRADE � �
OUGH PLUMBIC/- `rte.$ '7
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS 3 /2�
EWER OR SEgr1;,1 A
OUGH WIRING `/ 3� $
DUCT WORK
ROCK STORAGE
�66FOUND. REINF.a /' / c
�-fi'AS (ROUGH) �5 �Y
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
l%(,�REINF. STEEL 3 �G �J
Y'
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
INAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$ _$
LUMBER GR.efe,+INAL
INSP.
/RAMING#FINAL
,4/,fZROOFING
INSP. ��(r b
C
QRXw-
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
A� INSULATION/SOUND
FINISH GRADING
&/ FINAL INSPECTION
r
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL