04174 (GRES)• M
44
P.O. BOX 1504
Building70-323 To a Cotta Ct * LA QUINO
Address TA CALIFORNIA 92253.
•
Owner ;
Boulevard 'Deve3
-"Mailing .
Address .777 S. min Sty
City Zip •
Orange 92686
Contractor
BUILDING:'TYPE CONST.' • OCC. GRP
Suite 1016. w ., , , A.Pa Number.. q43-:790--001
t
Tel.
'� �..� �•�({ Legal Description
Project Description 9, 'Plan 2
City
Zip
Tel. `
State Lic.City
& Classif. °�
Lic. # ..., -
.Sq. Ft. V+
No. No. Dw.
Size
Stories •. Units
Arch., Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ •Demolition ❑
Address
Tel.
race included
City
Zip
State
Lic. #
LICENSED 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:: it
«1.x:',,, ..^ • �' '*
!�
'
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,Business and Professions Code: Any city or county which requires a
Estimated Valuation
$65#225
PERMIT
AMOUNT
permit to construct, after, improve, demolish, or repair any structure, prior to its Issuance afso
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) 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 civil penalty of not more than five hundred dollars (5500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Dep.
Plan Chk. Bal.
7 .t
Const.'
a
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 or property who
•._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
• or improvement 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.)
- Mech.
_
Electrical
1%%+ LV '
Plumbing
1' •
❑ 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.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
S.M.I. •-
_
- - ip�%«7` .
Grading
.
=
Driveway Enc.
_
MH2_r
Date Owner
Infrastructure
:�;.; .'•_.r�N
i•!yTAse-A YQUl'.
i1 x,1 �. ��ii4.,
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
$2,272.1 3 Com+ , ✓vJ �C ,
REMARKS
I"s "' +8,11$. 16 2611, l o"" z—ft. io
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S100) vaivation
Of 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.
St�'
,
_
r
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.
ZONE: BY: '
Minimum Setback Distances: • _ ;
;
Front.Setback from Center Line
Rear Setback from Rear Prop. Line
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.)
Side Street Setback from Center Line
.+° :i . - - - ,
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'
I certify that'I have read this application and state that the -above information Is coriecl
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. ' �.
,'
FINAL DATE
Issued by.
Validated by:
, ,• ,
l "
6/INSPECTOR
44140
- Date Permit
Signature of applicant - Date
•° Mailing Address
Validation:
GOLOENIIpD - 1111185E550R S OFFICE HARD COPY FILE
.4 > >.. _ ...�•.r_ ..�.�..„.,.vx_ ♦ ...1 .ire. .....epi, .1+,76rL.f ,.:�'L _ .'a'.1:.s'A . .i� .V.•-. tJ�.+.�`:R'{.:.
. City, State, Zip `
WHITE= FINANCE PINK APPLICANT, GREEN - 81JILDIN4,
��"Lf.. f!.w "rf. K'.+,. � ._ .i t, ..i; '.r.➢.� _ .. e. � .�. .� ....-. .._•tit .. ...s ... ..
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL'
2ND fl
POR
GAR
CAR P.
WALL
ESTIMATED CONSTRUCTION
SO FT (,2 S
UNITS
ROUGH PLUMB
SO FT. a
YARD SPKLR SYSTEM
MOBILEHOME SVC.
SO FT.
BAR SINK
tlY
SO. FT. fpr POWER OUTLET
ROOF DRAINS
SO FT. Ft
DRAINAGE PIPING
SOFT. Q
DRINKING FOUNTAIN
.
SO. FT. a
URINAL
VALUATION $
WATER PIPING
NOTE: Not to be used. as property lax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTONDISH)
APPLIANCE DRYER
p
FINAL INSP, �'
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
, C) o K
U ll
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESID tV: c
I ISEWAGE DISPOSAL
SO.FT.GAR r 3/,c
HOUSE SEWER
LATHING t—��—
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
i
SETBACK
GROUND PLUMBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE . Z g
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
I /
OUND. REINF. // i �� lL
(
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
p
FINAL INSP, �'
GRADING
cu.yd.
a —plus—x$
= E
LUMBER GR.
AMING may-
FING _ s �V
, C) o K
U ll
4 ( -
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SP K ARRESTOR'
&/A� IREWALL Z�
LATHING t—��—
MESH
SU IONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUBESIINITIALS
GARDEN WALL FINAL