05304 (AR)c6 4, 4 -14
P.O. BOX 1504 No. 0534
Building LA Q
Address bUINTA CAL CALIFORNIA 922534q-(MS'�� .
Owner
Mailing - BUILDING: -TYPE CONST. OCC: GRP. -
Address 41-625 I-CLECTIC _ A.P. Number
CityZip Tel.
P DE 32260 773-9024Legal Description PARC LA t313 A
ContractorProject Description ,fdt1{;N AWRY 'TAN TillT.n'f" q
Std NEW S`i RUC rON
Address ,
City Zip Tela
State Lic. City
& Classif. 3j7O73, Lic. # 1214 _ _ , Sq. Ft. No. , _ No. Dw. -
Arch., Engr.;
Size 1cle. Stories Units
Designer New ❑ Add -TIN Alter ❑ Repair ❑. Demolitiori'❑
Address' Tel.
City " Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under Provisions of Chapter 9 (commencing with Section' J ,
7000) of Division 3 of the Business and Professions Code, and my license is in full force and „f
effect.
N''
SIGNATURE DATE v
OWNER -BUILDER DECLARATION «� Estimated Valuation TTT_ Y
I hereby affirm that I am exempt from the Contractors License Law fo,rr the following y!
reason: ,(Sec. 7031.5,Business and Professions Code: Any city or ,county v;hlc`h requires a `
permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance also -N - ,i i -
requires the applicant for such permit to file a signed statement that he is licensed pursuant to • ,PERMIT •-r • - AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commenrmg with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis - for the atiaged exemption. Any violation, of Section 7031.5 by 'any applicant fora permit Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dogars (5500). ..
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal: 76.05
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. + 1 ? f►
Professions Code: The Contractor's License Law does not apply to an owner of property who + 11/ r00 `
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 -budder wig have the burden
of proving that he did not build or improve for the purpose o/ safe.) . r Electrical
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing I$ ���
struct the project. (Sec. 7044, Business andProfessions Code: Jhe Contractor's License Law •
does not apply to an owner of propertywhob,uilds or improves thereon, and who contracts for S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. 8. 8 P.C. for this reason Gradin9'lf
Driveway Erick,,
Date owner Infrastructure 204,3
WORKERS' COMPENSATION DECLARATION�
I hereby affirm that I have acertificate of consent oto self -insure, or a certificate of t
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company t"
❑ Copy is filed with the city. O Certified copy is hereby fumished. c
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE +
(This section need not be completed if the permit is for one humlred(2029ars (5100) valuation
or less.)
I 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 to the Workers' Compensation
Laws of California
Dat
1 '
TOTAL .!
REMARKS • DA05��t�.. Xv
Date
Owner
NOTICE TO APPLICANT: 1/, alter making this Certificate of Exemption you should become
ZONE: -
r
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, CW Code.) -
Side Setback from Property Line
Lenders Name
Lenders 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 information is
1/27/89.—Permit
above correct.
' 'I agree to'comply
Issued by:
Date -
with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of • this city to enter the above..
K'
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City,. State, Zip
r `1 .. < ..y, ,'.','1 •.,
- .. . `+ .. .t .. .. .. 41.. tl r �.• •
f r+�- a. 3�� \
' 1. _ < .,
�� 1.3'; r," ti '. .•�, �,;m {}_ <, ^.. s (�.�. ,1.'a
_ ... _ -. airy f .. -.� •moi
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING,
MOBILEHOME SVC.
BAR SINK
POR. Sp. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. @
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL Sp. FT.
-$
LUMBER GR.
FINAL INSP.
URINAL
Sp FT ®
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIREPLACE
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.
SO. FT. RESID ® 1 Va c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Y<c
HOUSE SEWER
CERT. OCC.
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
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING,
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
g plus x$
-$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL