002888 (SFD)44
P.O. BOX 1504 No. 002888
Building55-�3 C LA QUINOTAC
Address CALIFORNIA 92253
arwimEa3�
Mailing
Address 75-005 i MUY Club rive
CityZip 92261Q.. Tel.
228
Contractor
Address
saw
City lZip JTeC
State Lic. I City
& Classif..Lic. # 3n
Arch:, Engr., '
Designer
Address Tel.
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description 14 A
P12M TM
Ljvrk:ll 404
Sq. Ft. CM 42,E No. No. Dw.
Size Stories Units
New O. Add ❑ Alter ❑. Repair ❑
Demolition ❑.
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1'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
O Copy is filed with.the city. 0, Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i/ the permit is for one hundred dollars ($100) valuation
or less.) .. _
I certify that in the performance of lhg 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., 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.
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 representativesof this city to enter the above
mentioned property for inspectioh'purposes. �J! s a
Signature of applicant / f ' ' -�! �%t_ i Date. 10j
Mailing Address
City, State, Zip
HARD COPY
TOTAL
REMARKS -
ZONE:
BY:
Minimum Setback Distances:
City
Zip
State
Side Street Setback from Center Line
Lic. # .
Side Setback from Property. Line
UCENSED,CONTRACTOR'S DECLARATION
INSPECTOR
Issued by-
I hereby affirm that I=am licensed. under provisions of Chapter 9 (commencing with Section
u
7000) of Division 3.of'the Business and Professions Code, and my license_ is iin,fGll.force.and
Validation:
effect..
-
-
SIGNATURE'DATE
OWNER -BUILDER DECLARATION
a
I hereby affirm that I am exempt from the Contractors License Law for the following
Any.cfry
Estimated Valuation t t 7� 7 00
�
reason: (Sec. 7031.5,Business and Professions Code: or county :which requires a �
permit to construct, alter, improve, demolish, or repair any structure, 'prior to its issuance also
y •
,
requires the applicant for such permit to rile 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 therefrom, and the basis
for the Any Section 7031.5 by 'any for
Plan Chk.•.Dep.
alleged exemption. violation of appfcant. a permit
subjects the applicantto a civil penalty of not more than five hundred dollars ($500):
Plan Chk. BBI.
V �SlY
❑ 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. (Sec. 7044; Buisness and
Corlst
6�iB 0ti0Y3
Professions Code: The Contractor's License Law does not apply to .an owner or property who
. ,�1'
si
builds or improves thereon and who does such work himself or through his own employees,
'Mech.
'44.00.
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
Electrical
6W.41
.. - o/ proving that he did not build or improve /or the purpose of sale.) .
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
87.50
struct the project. (Sec. 7044, Business and Pro/essions.Code: The Contractor's License Law
does not to who builds or Improves thereon, and who for
S.M.I. -
. 5
apply an owner of property contracts
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
!ry s9
Grading
O I am exempt under. Sec. B. 8 P.C. for this reason
Driveway Enc.
Date owner
Infrastructuref:�.
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1'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
O Copy is filed with.the city. 0, Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i/ the permit is for one hundred dollars ($100) valuation
or less.) .. _
I certify that in the performance of lhg 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., 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.
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 representativesof this city to enter the above
mentioned property for inspectioh'purposes. �J! s a
Signature of applicant / f ' ' -�! �%t_ i Date. 10j
Mailing Address
City, State, Zip
HARD COPY
TOTAL
REMARKS -
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:
A7273
2 b 5i.21 Ci,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL F
NO. PLUMBING FEES
IST FL. SQ. FT. ®
UNITS
A.C. UNIT
2ND FL. SQ. FT. Q
SLAB GRADE 'a �'
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DRAINAGE PIPING
WALL SQ. FT. ®
DUCT WORK
DRINKING FOUNTAIN
SO. FT. ®
GAS (ROUGH) /
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
REINF. STEEL
FLOOR DRAIN
MECHANICAL FEES
TEMP. POLE
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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, 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
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FIREPLACE
GAS PIPING
PERMIT FEE
SPARK ARRESTOR
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE JELECT.FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
gjeSETBACK 1-9-q
ROUND PLUMBIN /2 ?r?
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 'a �'
t#OUGH PLUMB.y!�
BONDING
HEATING (ROUGH)
STORAGE TANK
![ FORMS
A046EWER OR SEPT7
OUGH WIRING C/ �U_ f
DUCT WORK
ROCK STORAGE
FOUND. REINF. ^
/
GAS (ROUGH) /
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
X15NAL INSP.
a�
BOND BEAM
WATER SYSTEM
$
GRADING
—cu. yd.
plus x$
_$
LUMBER GR.
NAL INSP.
1 FRAMING C/
lr�
A
LAINAL INSP. /' —?
ROOFINGp/: _, (/ /! G
!I
OEEE7771C✓T w
(
s�� yo/
d
REMARKS:
VENTILATION/^�/
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
v
C THING
MESH
I N SU LATIONISOU N D
FINISH GRADING
NAL INSPECTION J
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL