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14383 (BLCK)Abf P.O. BOX 1504 No. -1438-3 Buildingr• wy�78-495 CALLE TAMPICO Address 51 620. Ave. Vallejo LA QUINTA, CALIFORNIA 92253. - Owner Lt31 & YE.'zye11f►$e3:f` f BUILDING: TYPE CONST. -' -. OCC: GRP.-. • -c Mailing same Address A.P. Number ".City Zip Tel. _ Zip 92253 564-2.537 " Legal Description Contractor2©0" o ,'5' h"�.gth. v od ---Mobil, Concrete (Footings Only)Stucco vmll Project Description. ^'-'Address SZ�8 5 Ave. Vallejo State Lic. &'Classif.: -C-6' � 9270 Lic. # 3138 Sq. Ft. Size Arch:, Engr., _.Plumbing Designer -New ❑ Add -0, 'Address Tel. Driveway Enc. City Zip State ... , 'Lic: # _LICENSED CONTRACTOR'S. DECLARATION .. .. '. 1 hereby affirm that I am licensed under provisions of Chapter. (commencing:with.Seclion 7000) of Division 3 of the Business and Professions Code, and my license is in full'force and < effect. ' - I hereby affirm that I have a'certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or certified copy thereof. (Sec. 3800, -.Labor Code.) . SIGNATURE -DATE ' ' - OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law. for the following, Estimated Valuation . reason:. (Sec. 7031.5, Business and. Professions Code: Any city or county which- requires, a • . permit to construct, alter, •improve, demolish, • or repair any structure, prior 'to -its issuance also requires 'the applicant. for such permit to Elle. a signed statement that he' is licensed pursuant to O.Copy.is filed with the city. O Certified copy is hereby furnished. PERMIT- ERMIT•the theprovisions 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 -i031.5 by. 'any applicant for a. permit TOTAL Plan Chk, Dep. - subjects the applicant to a civil penalty of not more than rive hundred dollars ($500). O I, 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 isnot intended oroffered.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' ' 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.) . No.,• Stories Alter• El I'l 532'. 00 No. Dw. Units Repair O ' 'Demolition:❑.. Chi; a owner of the property, am exclusively contracting with licensed contractors to con-.,- • strucl-the project. (Sec. 7044, Business and Professions -Code: The Contractor'srLtcense.Law does not apply to an owner of property -who builds or improves. thereon, and who. contracts for such projects with a contractors) licensed pursuant to the Contractor's -License Law.) ' OI am exempt under Sec: ` B. 8 P.C. for this reason J _.Plumbing . S.M.I: Grading- Driveway Enc. .. .. Date t rtt,. Owner r Infrastructure , 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 certified copy thereof. (Sec. 3800, -.Labor Code.) . - ' Policy No. Company O.Copy.is filed with the city. O Certified copy is hereby furnished. •' TOTAL 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 thg work for which' this permittis issued, f 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: ff,.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 Dista_ k6s: • .. - ' Front.Setback from Center Line Rear Setback from Rear Prop. Li 'e` WARNING: FAILURE TO SECURE. WORKERS; COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO -ONE Side Street Setback from Cen ne HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,' Side Setback .from Propert DAMAGES AS PROVIDED FORAN SECTION.3706 OF THE LABOR*CODE; INTEREST, AND ATTORNEY'S FEES. This is a buildin g permit when properly filled out, signed and.validated; and is subjecl'to expiration if work thereunder is suspended for 180 days. FINAL DATE Q " • ' .I.NSPE R , ` v r ,Q n 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:'4o• enter the 'above-. mentioned property for in purposes; Signature of applicant— Date— ate MailingAddress Mailing Issued by: Validated by: Validation-: ✓ Date v Permj t / /! • / s �f City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINU FEES 1ST FL. SO. FT. p $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. p FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SO. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SQ. FT. GROUT WATER HEATER WALL SQ. FT. FINAL INSP. DRINKING FOUNTAIN SO FT ® WATER SYSTEM 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.000L HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING IKITCHEN 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 LATHING 91MA9 A01 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1 Va c SEWAGE DISPOSAL SO.FT.GAR ® 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 GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. 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 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING 91MA9 A01 - MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIONATURESIINITIALS GARDEN WALL FINAL