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14193 (RPL)I 3 Building Address 53-390 VALLEJO Owner SID AROEN T -*iy/ 4 4Q" P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mailing Address 53-390 VALLEJO City LQ Zj.P;,2253 TeI771— 456 Contractor BRUCE G TAMLILS Aooress P{3 BOX -1524 City lzih Telai'AZ>F'�°i DESER `'92.260 568-4963 State Lic. Ca3483498 City 2453 & Classif. Lic. # Arcn.; tngr:, -Designer Address Tel. City I Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70 130) of Division 3 ofthe Business and Professions Code, and my license is in full force and { effeCLti.. � � .(+ „3,. r�-�� :a%i"CQe_t _SIGNATURE - DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following ' I 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 rile a signed statement that he is licensed pursuant to the proOsions 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 civil penalty or not more than five hundred dollars ($500). ❑ 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 Professions Code: The Contractor's License Law does not apply to an owner of property who 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 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.) ❑ I, 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 contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt 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 - ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (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 permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. �y Date t!ti' 1;'. ,"COwner _ N-0-.-� NOTICE TO APPLICANT. If, 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. f - CONSTRUCTION LENDING AGENCY 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.) Lender's Name 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. 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. Signature of applicant Date Mailing Address City, State, Zip BUILDING: TYPE CONST A.P. Number No. 34193 OCC: GRP..— Legal RP._ Legal Description _ Project Description PWS Sq. Ft:' . Size ' New ❑ No. Stories No. Dw. Units Add .❑ Alter ❑ Repair. ❑ - Demolition ❑ ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback fro rop..Line Sid reet Stack Center Line Suck m P 0[D v Line FINAL DATE Issued by:— Valid ated y:_Validated by: Validation: Permit Estimated Valuation 12,000 PERMIT AMOUNT Plan Chk. Dep. ` Plan Chk. Bal. !0 Const. 1y3. UU Mech.� •• Electrical Plumbing e' 1, 0U .S.M.I. Grading Driveway Enc. Infrastructure ;o ` c t TOTAL 348.45 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback fro rop..Line Sid reet Stack Center Line Suck m P 0[D v Line FINAL DATE Issued by:— Valid ated y:_Validated by: Validation: Permit STRUCTURE / PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING Q 1) CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. @ $ UNITS HEATING (ROUGH) STORAGE TANK FORMS YARD SPKLR SYSTEM 6� 2ND FL. SO. FT. @ DUCT WORK ROCKSTORAGE FOUND. REINF. MOBILEHOME SVC. ,. ' BAR SINK POR. SO. FT. @ OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) POWER OUTLET ROOF DRAINS GAR. SO. FT. @ GROUT WATER HEATER SERVICE FINAL INSP. DRAINAGE PIPING CAR P. SO. FT. @ WATER SYSTEM GRADING cu. yd. $ -Plus-X$-=$ DRINKING FOUNTAIN. WALL S0. FT. @ FINAL INSP. FRAMING FINAL INSP. URINAL SO. FT. @ ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation VENTILATION FLOOR DRAIN MECHANICAL FEES FIRE ZONE ROOFING WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER ': - I 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 @ 11/4 c SEWAGE DISPOSAL SO.FT.GAR @ 3/ac HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE I I MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE / PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING Q NDERGROUNDA.C. UNIT COLL, AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCKSTORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. 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 MESH I NSU LATI ONISOU N D FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL11416PECtOWSSIGNATURESIINITIALS GARDEN WALL FINAL 'p,�u�dP �'I.ctal pmbn Te POOL AREA TO BE ENCLOSED BY MiNi{yM 5FT.-+}}f H FENCE. ALL GATES TO BE SLF-CLOSING AND SELF-LATCHIN . !6 --4. CITY OFA QUe, lL�I�lG : S' HET�Y DEP RTMENI Y ' . iBU DITICINALL`f ifyr~TED0 GON°STlU TION= SUBJECT M LATION A PER f AND ALL APPLIC ABLE C D 1,).ATE La���� ,l i R i 'p,�u�dP �'I.ctal pmbn Te POOL AREA TO BE ENCLOSED BY MiNi{yM 5FT.-+}}f H FENCE. ALL GATES TO BE SLF-CLOSING AND SELF-LATCHIN . !6 --4. CITY OFA QUe, lL�I�lG : S' HET�Y DEP RTMENI Y ' . iBU DITICINALL`f ifyr~TED0 GON°STlU TION= SUBJECT M LATION A PER f AND ALL APPLIC ABLE C D 1,).ATE La����