08834 (BLCK)4
Building
Address
Address 41.1 . Calle Familia
44 Q
P.O. BOX 1504• C' }C N 0 .
78-105 CALLE ESTADO
3 LA QUINTA, CALIFORNIA 92 253
BUILDING: TYPE CONST. OCC: GRP.
City Zip Tel.
Carlsbad 92672 632-7658
Controrfr.,..a-
Address `
-5
/State
3 -a
Lic.City
& Classif. 3 3 .a�V T
Lic. #
Arch., Engr.,
Designer
Address
Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
:x00 0) of Division 3 of the Business and Professions Code, and my license is in full force and
NER�4fILDER DECLARATION -
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec..7031.5,Busfn. and Professions Code: Any city or county which requires a
permit to construct, alter, im ove, demolish, or repair any structure, prior to its issuance also
requires the applicant for su permit to file a signed statement that he is licensed pursuant to
the provisions of the Cont, tor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business d Professions Code, or that. he is exempt therefrom; and the basis
for the alleged exemptio Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a vil penalty of not more than live hundred "dollars ($500).
I, as owner of the pr, erty, or my employees with wages as their sole compensation; will
the work, and the.,
he s ucture is not intended or offered for sale. (Sec. 7044, Buisness and
rnfessions Code: The ontractor's License Law does not apply to an owner of property who
builds or improves the on and who does such work himself or through his own employees,
provided that such im ovements are not intended or offered.for sale. If, however, the building
or improvement is sol within one year of completion, the owner -builder will have the burden
of pioving that he did n build or improve for the purpose of sale.)
❑ 1, as owner of the roperty, am exclusively contracting with licensed contractors to con-
struct the project. (S C.
7044, Business and Professions Code: The Contractor's license Law
does not apply to an o ner of property who builds or improves thereon, and who contracts for
such projectswlth a cont tor(s) licensed p suant to the Contractor's License Law.)
O I am exempt under Se & P.C. for this reasAn J
Date Owner
WORKERS' COMPENSATION DECLARAMN
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a ce`o thereof. ( 800, La�jCode.)
c
P o.. Company P
opy is filed with the city. .O 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
,=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 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.
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 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.
Signature of applicant Date
Mailing Address
City, State, Zip
P. Number
Legal Description
Project Description 31' Ai-ar-k Rt�_,4airincr WAIA
Sq. Ft.
Size
New ❑
No.'
Stories
No. Dw.
Units
Add ❑ Alter ❑ Repair ❑ Demolition :1
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech. '
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
AMOUNT
REMARKS
dilT3#
10 1 1, U M fit. 1 4a. ir 11
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:'
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ, FT, ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. @
GAS (FINAL)
TEMP. POLE
WALL SQ. FT. @
DRINKING FOUNTAIN
SQ FT ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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LAUNDRYTRAY
AIR HANDLING UNIT CFM
REMARKS:
KITCHEN 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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
MESH
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
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/A&
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL