04182 (CGAR)04,182
P.O. BOX 1504
Building 78-363 ftrra Cotta Ct. 78-105 CALLE ESTADO
Address LA,QUI.NTA,,rALIFORNIA,9225-3.,,
Owner
Boulevard MV61opmnt
•
BUILDING:'TYPE CONST. OCC. GRP.-
Mailing - - .. -1 -
Address 777 Si Main St.. $,Uite 106, _A.,P.Number . 6-13-790-001
City Zip Tel.
bran Legal Description
Oita 92686 T�714-r:j54l7-8 056 . ,� � ... .. - I � . �eui
Con•tractor Pr _ I oject D — Description
1din.
q 11r plat 2�
Sam
Address
City
State Lic.
& Classif. 462814
Arch., Engr.,
Designer
Address
Lic. # Sq.,Ft.
Size
I
Te -1.
9.12 No.
Stories
No. Dw.
Units
New 0 Add 0 Alter 0 Repair 0 Demolition 0
included
CityZ
1ip
State
Lic. #
A
iCENSED CONTRACTOR'S DECLARATION
I here h lic'n
b.y.afiir*m I at -.I am a sed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 df.,the Business and Professions Code, and my license is in full force and
effect:�V!7!:�,'.4,
or.
SIGNATURE DATE
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
Estimated Valuation
ry
PERMIT
AMOUNT
permit to construct, after, improve demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
the provisionsof- 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
Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
0 1, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Bal.
Const.
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
Mech.
: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
Electrical
4 16
; improvement is sold -within one year of completion, the,owner-builder will have the burden
• 04
0proving that he did not build or improve for the purpose of sale.)
ntractors to con-
0 1, as owner of the property, am exclusively contracting with licensed contractors
Plumbing
75 4,011
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.)
0 1 am exempt under Sec. B. & P.C. for this reason
S.M.I.
4a 59
Grading
Driveway Enc.
Date -Owner
Infrastructure
1 t 467 • 57
vring's-WISCI
Ll ZaVd 6 J. ti
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 l'is hereby furnished.
TOTAL
I a 7 1
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thip 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
ng 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 shag be deemed revoked.
ZONE: BY:
Minimum Setback Distances:
—Front
Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY.
--Side
St - re6t Setback from CenterLineI
hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 309.7, Civil Code.)
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.
FINAL DATE
INSPECTOR,
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.
Issued by:
Validated by:
Date —Permit
Signature of applicant Date
Mailing Address
Validation:
,,City, State; Zip
GOLDENROD ASSESSOR'S OFFICE,- HARD COPY. - FILE
WHITE -FINANCE, PINK - APPLICANT ,' GREEN w BUILDING,
A
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
ISI FL SO FT y $
UNITS
COLL. AREA
LAB GRADE D
ROUGH PLUMB
YARD SPKLR SYSTEM
2ND FL SO FT. R
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR SO FT. a
ROCK STORAGE
ND. REINF. / K ►-g c6
GAS (ROUGH)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. tir
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CARP. SO FT. 6
GROUT
WATER HEATER
DRINKING FOUNTAIN
WALL SO. FT. a
BOND BEAM
WATER SYSTEM
URINAL
SO. FT. 43
_$
LUMB R GR.
ESTIMATED CONSTRUCTION VALUATION $
Z.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVARCOOL HOOD
SIGN
WASHER(AUTO)(DISHI
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
MESH
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESID (d t V. c
SEWAGE DISPOSAL
FINISH GRADING
SO.FT.GAR rp V4c
HOUSE SEWER
FINAL INSPECTION
GAS PIPING
PERMIT FEE
CERT. OCC.
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
SETS K
ROUND PLUMBINCY,?-2-JVP
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE D
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
ND. REINF. / K ►-g c6
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$
_$
LUMB R GR.
FINAL INSP.
Z.
FINAL INSP.
ROOFING
�
\ /
Y `
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
G R. FIREWALL
MESH
IN ULATIONISOUNDZ�7�
--//
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGHATURESlINITIALS
,
GARDEN WALL FINAL