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15083 (BLCK)4 P.O. BOX 1504 Building 78- 79-3�0 Tom FaZio Lane LA QUI Address Owner Mr* & Mfrs. Bills. Narrow "Mailing ' • Address 79-30 TOM Fa$i© Lane .City Zip Tel. ' . La menta 32253 773a0012 . Contractor Robert Taylor Xaso my Address 42-•200 Beacon Bill Ste A. gaim 32250 Dessert zip Tel.: 773-0022 State Lic. City & Classif. - Lic. # Arch., Engr., Designer Address Tel. 495 CALLE TAMPICO NTA, CALIFORNIA 92253 CityZip State Lic. # UCENSED.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. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason: (Sec.. 7031.5,8usiness and Professions Code: Any city or county which requires a permit to construct, atter, 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) o1 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. (Sec. 7044, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of propertywho builds or, inproves 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 orimprovement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to corF 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 contractors) Oansed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason , Date Owner 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. . O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (This section need not be completed it 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. Date _ Owner NOTICE TO APPLICANT. If, eller making this Certificate of Exemption you should become subject to the Workers' Compensation provisions or the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL; AND SHALL SUBJECT AN EMPLOYER. TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR. CODE, INTEREST, AND ATTORNEY'S FEES. This is a building permit'when properly filled out, signed and validated; and is subject to expiration it 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 Date Mailing Address City, State, Zip No. 15083 LDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description Project Description Garden .mall 248". @ V Sq. Ft. No. No. Dw. ' Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop, in Side Street Setback from» s� ` t�r Linea Estimated Valuation '$6r200.00 Side Setback from P, e y,Llne -1� PERMIT AMOUNT Plan Chk..Dep. .. Date Perm+t Plan Chk. Bal. 99 Const: $90.00 Mech. ' Electrical \ Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL S90.00 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop, in Side Street Setback from» s� ` t�r Linea Side Setback from P, e y,Llne -1� FINAL DATE INS&ECTJ_0, ,\ AC Issued by: Date Perm+t 99 Validated by: Validation: \ CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS COLL. AREA 2ND FL. SQ. FT. p YARD SPKLR SYSTEM BONDING MOBILEHOME SVC: BAR SINK POR. SQ. FT. ® WE EPTIC TANK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS OUND. REINF. DRAINAGE PIPING CAR P. SQ. FT. HEATING (FINAL) OTHER APP.IEOUIP. WALL SQ. FT. DRINKING FOUNTAIN SO. FT. ® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FINAL INSP. LAUNDRYTRAY 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. SQ. FT. ® c BATH TUB FIREPLACE SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR Q 3/ac HOUSE SEWER 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 OUND PLUMBIN UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE UGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS WE EPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE OUND. REINF. (ROUGH) 9� c METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. ` ^ BOND BEAM 7 /, ((( WATER SYSTEM GRADING , cu. yd. $ 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