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03987 (BLCK)P.O. BOX 1504 ®„�q.7.8 105 CALLE ESTADO Building C Address ?9. 2%7 S o SUA Set R „LA 67 NTA, CALIFORNIA .92253 Owner Xarcua, Conrad Mailing BUILDING. TYPE CONST. OCC. GRP. Address DOX 1342. A.P.'Number La OuLata Palms CityZip Tel. va,ii`?3. aesert 9226 � Q9 „ , Legal Description s Contractor y� � T Project Description A* X 401 Pence 5 Address State Lic. & Classif.. Arch., Engr., Designer Address Zip I Tel. City Lic. # Tel. Sq. Ft. Size No. Stories ` New ❑ Add ❑ Alter ❑ i No. Dw. Units': Repair ❑ Demolition ❑ 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 Divisionof the Business and Professions Code, and my license is in full force and .3 effect. •+ •' SIGNATURE DATE OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation r A An a X60'0; 00 reason: (Sec. 7031.5,Business and Professions • Code: Any city or county which requires a '� PERMIT AMOUNT permit to construct, alter,.fmprove, demolish, or repair any structure, prior to its issuance also q applicant'lor such permit to Ills a signed statement that he is licensed pursuant to ' requires the the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) o/ - Divlsion 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis /or the alleged exemption. Any violation o/ Section 7031.5 by any applicant for a permit Plan Chk. Dep. subjects the applicant to a civil penalty o/ not more than live hundred dollars (8500). Plan Chk. Bal. . '`•. ❑ I, as owner of the Pro property, or m employees with wages as their sole compensation, will CiOr1St. , �{'� n; do the work, and the structure is not intended or offered for sate. (Sec. 7044, Buisness and Professions Code: The Contractor's License Law does not apply to an owner o/ property who w �.. 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. 1l, however, the building Electrical or Improvement is sold within one year o/ completion, the owner -builder will have the burden of proving that he did not build or improve /or the purpose of sale.) Plumbing ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- - Strutt the - project. (Sec. 7044, Business and Professions Code: The Contractor's License Law S. M. 1. 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.) Grading ' ❑ 1 am exempt under Sec. B. t: P.C. for this reason • Driveway Enc. r-'''�� Infrastructure + Date -t-fes owner"" i 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. r TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS - WORKERS' COMPENSATION INSURANCE v - (This section need not be completed it the permit Is for one hundred dollars (8100) valuation orless.) 1 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. , ' F Date Owner, NOTICE TO APPLICANT., ll,',afer making this Certificate o/ Exemption you should become - ZONE: •' BY - - - '^ subject to the Workers' .Compensation provisions •of: the Labor Code, you must, forthwith ' ' ' • comply with such or this shall be deemed - ` - a „� + •r' •^ 34 .e t1 '$" ; Mlnirnum Setback Distances.�4`y i�}'' ;'•��' �C,� provisions permit revoked.. • _ " w r �,,{�srt :'Front Setback from Center Line Setback from Rear,Prop: Line, 1 =Rear ~•: CONSTRUCTION LENDING AGENCY ,. " : SidetStreetI Setback from Center Line "Side I hereby affirm that, there is a construction lending agency for,the performance of the , work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line Lender's Name d Lender's Address ' n� FINAL DATE '-INSPECTOR ' This is a building permit when properly filled out, signed and validated, and is subject toad4� • expiration if work thereunder is suspended for 180 days. . . I certify that I have read this application and state that the above information is correct. Issued by: Date Permit • I'agree to comply with all city and county ordinances and state laws relating to building - construction, and, hereby authorize representatives.- of this. city to enter the above- bove mentioned mentioned property for inspection purposes. + ' Validated by:,. y:-- Signature Signature of applicant' ( Date Mailing Address - - '' - - Validation: 4J135E65OR S OFFICE, HARD COPY, = FILE City, State, Zip t i :.WHITE FINANCE, PINK - APPLICANT GREEN'- BUIIDIMG;'GOLOENpOD .."t.,.�y.-•l;:is r.�'^. .^-. 1-t.t-_ r9:,'rt»a."fir',.-, .f A. 1.-.. .c' f`uJiro!'Y: n .I.;.:.e':--.�i M,; ,. .! ., ,:x:' -. �.:.±f'. \.. f 4'�4i; .r Lee-i.n "...m., 1 w... X.'4'j' Xi` - 4' C _�:,•.5^:, .,.:� {S`�. rr. K .1..,T..' ... ... _e'� CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO FT y S UNITS SLAB GRADE ROUGH PLUMB BONDING YARD SPKLR SYSTEM 2ND FL SO FT. q FORMS SEWER OR SEPTIC LANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR SO FT at GAS (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR SO. FT. Cr TEMP. POLE GROUT DRAINAGE PIPING CARP. SO FT. 0 1 1 BOND BEAM WATER SYSTEM DRINKING FOUNTAIN WALL SO. FT. (d =$ LUMBER GR. FINAL INSP. URINAL SO. FT. a 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.000L HOOD SIGN WASHER(AUTONDISH) APPLIANCE DRYER FIREPLACE 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 SO, FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID a 114 c SEWAGE DISPOSAL SO.FT.GAR @ 14c 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 8 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 LANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. 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. FRAMING FINAL INSP. ROOFING AAA r U REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR' GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS _ GARDEN WALL FINAL