04260 (SFD)— — — — — — — — — —
y ,
'r •� ,nary 't"'i:{'A-.`.� TA
P.O. BOX 1504
-Building
.78-105 CALLE ESTADO
Address,- 70—i64, -Terza Cotta Cto LA.9UJINTAt.CALIFORNIA 92253
Owner
10 Boulevard Develoomm
Mailing
Address 773 S. in St,, Suite
TI
'7;
BUILDING: ;TYP&CONST�. OCC. GRP.
A.P. Number 613-790-001
0426"T
,Cityp e
Orage n 92696 714-:547-:4056 Legal Description
.Contractor Project Description
Address Palm Royale Plan 3 R SlUildin4 11
Cityrip Tel.
State.Lic: City
& Classif:, Lic. #
Arch.,,',Engr.,
Designer,,,.,"
Address,*.,,,, Tel.
City1Zip State Z Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm thaf.1 am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division of the Business and Professions Code, and my license is in full force and
effect. .
Z
SIGNATURE i1 I . I ', o' ", ' r.,FDATE
I '* I OWNER -BUILDER DECLARATION
I hereby . affirm that I 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
pprmit:to construct, alter, Improve, demolish, or repair 'any structure, prior to Its issuance also
requires:tfte 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 civitpenafty, of not more than five hundred dollars (5500).
0 1, 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 property who
builds;
of improves thereon and who does such work himself or through his own employees,
provided that 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
ofprovingthathe did not build or improve for the purpose of sale.)
0 1, 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 conir6ctor(s) licensed pursuant to the Contractor's License Law.)
0 1 arrexe'mp't 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
0 Copy is filed with the city. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
Sq. Ft.
Size 7,63
No.
Stories
No. Dw.
Units
New 0 Add 0
Alter 0
Repair 0 Demolition 0
I certify that in the performance of thp 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 N after making this Certificate of Exemption you should become
ZONE:
BY:----;..
Estimated Valuation
Wt$86
Distances:
PERMIT
AMOUNT
Plan Chk. Dep.
Front Setback from Center Line
Plan Chk. Bal.
Rear Setback from Rear Prop. Line
252
Const.
Side Street Setback from Center Line'
304.00
Mech.
33.00
Electrical
Side Setback from Property Line
-41 .78r
Plumbing
63.00
S.M.I.
INSP-ECTOR'
3.96
Grading
expiration It work thereunder is suspended for 180 days.
Driveway Enc.
I certify that I have read this application and state that the above information is correct.
Infrastructure11
Date Permit
279024 J
construction, and hereby authorize representatives -of this.City to enter the above-
mentioned property , to . r inspection purposes.
'Validated by:
Signature of applicant Date
Mailing Address
TOTAL
$2MS.07
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(Thissection need not be completed if the permit is for one hundred dollars (5I00) valuation
or less.)
I certify that in the performance of thp 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 N after making this Certificate of Exemption you should become
ZONE:
BY:----;..
subject to the Workers' Compensation provisions of the Labor Code, you • must forthwith
Minimum Setback
Distances:
comply with such provisions or this permit shall be deemed revoked.
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
a
• work for which this permit is issued. (Sec. 3097, Civil Code.)
Side Setback from Property Line
Lender's'
-Narne
Lender's. Address'
FINAL DATE
INSP-ECTOR'
This is a building peimit 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.
-Issued by:
Date Permit
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 , to . r inspection purposes.
'Validated by:
Signature of applicant Date
Mailing Address
rValidation:
City,'State, Zip
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD-- ASSESSOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO F1 y $
UNITS
'LAB GRADE/,? �7
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. gt
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
MOBILEHOME SVC.
BAR SINK
POR SO FT. a
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
POWER OUTLET
ROOF DRAINS
GAR SO. FT. or
GROUT
WATER HEATER
DRAINAGE PIPING
CAR P. SO FT. 6
BOND BEAM
WALL SO. FT. (V
DRINKING FOUNTAIN
-$
LUMBER GR.
URINAL
SO. FT. a
FINAL INSP.
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
WASH ER(AUTONDISHI
APPLIANCE DRYER
FIREPLACE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
IKITCHEN 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 @ t w c
SEWAGE DISPOSAL
SO.FT.GAR rg
HOUSE SEWER
CERT. OCC.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL.FEES
MICRO FEE
MECH.FEE PL.CK.rEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
OUND PLUMBINti/%
ZUNDERGROUND
ry
A.C. UNIT
COLL. AREA
'LAB GRADE/,? �7
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
/
OUND. REINFf %�
(( �i
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
GRADING
cu. yd.
$ plus x$
-$
LUMBER GR.
FINAL INSP.
AMING 2 �^C2-
(J
FINAL INSP.
ROOFING
,/(Q
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR"
GA,R. FIREWALL
G 2 Z
MESH
I ULATIONISOUND Zr2-f
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
,
GARDEN WALL FINAL