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04557 (BLCK)�� p .:Y�'`�"' •�.,.44 •f' 'kms. r ,A' •V r1 i4 ' -elf. ',.t: i -n. '• P.O. BOX 1504 - t;., r .. _ .. rBuilding 78-105 CALLE ESTADO �r Addressi, -514460 Vallejo. { .a ,LA QUINTA, CALIFORNIA 92253 ..Owner. rc. i �+ ,q ,Lawreacah Schroe&ar ' ` BUILDING:, TYPE CONST. OCC. GRP. Mailing.: -' '•: . . Address :_;,,5�:•^I'573' llal 'i3Ct3: 773-172-006 .>, A.P. Number. City t ., ti Zip Tel. ~ 92 µ - 0— q64 Legal Description 01 n retaining 11 Project Description1 Cal llagw Construction Address ' r • :7"4 1903 Ve1i0 Way A.. City# Llm •De "al"t Zip � +26Q Tel.. State Lic: City . & Classif. -3587 9 Lic. # 926 Sq. Ft. No. No. DIN.' ` ' Size Stories Units Arch., Engr., Designer r, New ❑ /Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address K Tel. 1 ct. City Zip State Lic. # LICENSED CONTRACTOR'S"DECLARATION I hereby affirm that I am licensed under provislons:of Chapter 9 (commencing with Section 7000) of Division 3,of the Business and+P slons`Code; and my license is in full force Dfe and at ect. c' SIGNATURE "' DATE OWNER -BUILDER DECLARATION Estimated Valuation ' I hereby affirm that I am exempt from the Contractor's License Law for the following 1 reason: (Sec. 70315,Business and Professions Code: Any city or county which requires a ®54g - PERMIT - '• , AMOUNT, ` i permit to construct, alter, improve, demolish, or repair any structure, prior to its Issuance also 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 Any Section 7031.5 for Plan Chk. Dep. - y` t for the .alleged exemption. violation of by any applicant a permit subjecWthe applicant to a civil penalty of not more than five hundred dollars ($500). Plan Chk. Bal.. v.❑ I, 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 CipnSt. . • - i�j' i Professions Code: The Contractor's License Law does not apply to an owner of property who Mech. Y 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 s 1 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 or sale.) Plumbing O'1, -`as owner of the property, am exclusively contracting with licensed contractors to con- ristruct-lhe 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 S.M.I. -.50 such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading _ O•I am exempt under Sec. B. 8 P.C. for this reason Driveway Enc. Date ' Owner Infrastructure - M• WORKERS' COMPENSATION DECLARATION hhereby 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 ✓l �` 0 Copy is filed with the city. O Certified copy is hereby furnished. TOTAL r- CERTIFICATE OF EXEMPTION FROM REMARKS • WORKERS' COMPENSATION INSURANCE (This;section need not be completed 1l the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg work for which this permit is issued, I shall not +Afar i ^Y WA N'A4xl 9 $ #.,, }rf, ry ; .ej `• °' employ any person.in any manner so as to become subject to the Workers' Compensation Laws of California. " - --• ••-- - ••- - - - -•-- - - Date ' Owner NOTICE TO APPLICANT:. If,alter making this Certificate of Exemption you should become ZONE: BY: ' subject to the } Workers' Compensation provisions or the Labor Code, • you must forthwith' comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances: •' •(; , 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 } whic work for h this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line, Lender's 'Name Yr FINAL DATE—INSPECTOR ' 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..8/31/88- 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 for inspection purposes. i` Validated by: ^ Signature of applicant Date Malling- Address Validation: City, ,`State; Zip GOLDENROD- ASSESSOR'S OFICE;HARDCOPY ._ ..... n� -✓.....`- FILE :.F,,.S i s "N! ,.... .i - . s is ,� .,J '. !^S. "' 'Cir, ,.S• r ' -FINANCE, PINK APPLICANT, GREEN -BUILDING, .... . ..,.a ,,... es.�. .. • CONSTRUCTION ESTIMATL NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO F1 (a $ UNITS ` VVsk-AB GRADE 16' C/ p ROUGH PLUMB BONDING SPKLR SYSTEM 2ND FL SO FT. (tYARD FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR SO FT. at GAS (ROUGH) / METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR SO. FT. la TEMP. POLE GROUT DRAINAGE PIPING CAR P. SO FT. Ft FINAL INSP. . BOND BEAM WATER SYSTEM DRINKING FOUNTAIN WALL SO. FT. @ =$ 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.COOL HOOD SIGN WASHER(AUTONDISH) 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 I'A c SEWAGE DISPOSAL SO.FT.GARgr 3Vc 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 'J SETBACK �6-�/ GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA ` VVsk-AB GRADE 16' C/ p ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE REINF. GAS (ROUGH) / METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. /FOUND. [ REINF. STEEL ltJ- �/ ' 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 MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATUF.ESlINITIALS GARDEN WALL FINAL