08049 (SFD)Building
Address i-655 Vallejo
Owner
Robert D. Chaml
Address
7911 Calle Madrid _
City Zip Tel.
Contractor
Address
9//'
State Lic.I City
_,V, n
& Classif. P n /1-7 Lic. #
Arch., Engr., '
Designer
Address Tel.
City ( Zip( State
Lic. #
4
P.O. BOX 1504 C N o . 08049
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 922537
oLf-U9V-1 S�
BUILDING: TYPE CONST. OCC: GRP.
LICENSED COrrTRACTORIS DECLARATION
eby affir at 1 am licensed�un�er provisions of Ch4ptpt 9 (commencing with Section
of Divisi n of a Wsjge n fjSof�sion§ qodep2U my license is in full force and
r (/ OWNER-BUILW DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
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 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
for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of 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
or 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.)
❑ I am exempt under Sec. ,aR. & P.C. for this
te
Date caner of .✓'/K . 't c3.��
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 ce d o y th�epreof.ra�,p 3800, Labo ode.)
Poli�c1' No. Company�C r6
�.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 the 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.
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 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
A.P. Number 774-122-018
Legal Description Lot 7
Project Description Sinale Fmily lWall ing
Sq. Ft.No. No. Dw.
1
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
r
stimated Valuation
$94,984
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const..
A191, K"s
Mech.
62 00
Electrical
Plumbing'
S.M.I.
CQ
Grading
2000
Driveway Enc.
20-00
Infrastructure
w
SiQ
TOTAL
sb •
s� •��
REMARKS
�c r
Lii7�'-8'x "+bP4r+ k' tta i9Y'.r
..^':• :,�r,;v lb�t a 'II.
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 5/3Q/gOPermit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
'
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM c
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEQUIP.
DRINKING FOUNTAIN.
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.7�/l
r
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SPARK ARRESTOR
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
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 ello-71,09
BINVftf
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 2
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. A,
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.7�/l
r
FRAMING
FINAL INSP.
ROOFIN Z Q
GG
J111V /o
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND ` 3
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
POMONA FIRST FEDERAL SAVINGS AND LOAN ASSOC'ATION
W N. Indian Hill Blvd., Pomona, CA 91769
P O. Box 3069, Pomona, CA 91769 Attn: Construction Disbursement Dept. Loan No.
Tract
one lot involved, show Lot Nos.)
(Description of labor, services, equipment or material furnished) (through
date)
(property a dress)
Y)
THIS VOUCHER MUST BE ACCOMPANIED BY PAYEE'S INVOICE. THE LABOR AND MATERIAL WAIVER AND RELEASE ON
REVERSE MUST BE COMPLETED.
For the purpose of inducing PFF to make payment of the above sum, the undersigned certifies that the above described labor,
services, equipment, or material have been actually performed or delivered by the persons, firms or corporations named herein,
and that they conform to the plans and specifications for the job submitted to PFF and that there is no agreement to accept any
rebate or "kickback" of money, labor, services, equipment or material from any person or firm with respect to this Voucher. The
undersigned also unconditionally requests PFF to pay this Voucher in full and holds PFF harmless in connection with such
payment.
(Telephone No.) (Date)
A VOUCHER WILL NOT BE PAID IF THE WORK COVERED
CONSTRUCTION INSPECTOR.
California Penal Code Sections 484b and 484c provide that it is a crime to willfully submit false Vouchers and/or misuse
construction loan funds. A Voucher may be mailed in or presented for payment in person during regular office hours. PFF must be
notified one day prior to presenting a Voucher of $100,000.00 or more.
The following Certification is a part of the Labor and Material Waiver and Release on the reverse side of this document.
For the purpose of Inducing Pomona First Federal Savings and Loan Association to Issue a check in payment of the total amount
shown on the face of the accompanying voucher ($ amount of voucher) the undersigned Payee represents and cer-
tifies: (1) that the labor, services, equipment, or material, set forth below, have actually been furnished to the job site described
below (or materials have been taken from Payee's stock If Indicated); (2) that unconditional payment for such labor, services,
equipment, or material (Including any fringe benefit payrrents due pursuant to a collective bargaining agreement) has actually
been made In full to the date Indicated on the accompanying voucher, or that If any of such amounts remain unpaid, the proceeds
Of the accompanying voucher are being taken In trust for their payment; (3) that the listing below of laborers, material or equip-
ment suppliers, and subcontractors Is a full and complete listing of all those who were employed (or delivered services, equip-
ment, or material) for this job In connection with the work described below; and (4) that there are no straw or dummy persons, ncr
Padded bills, Included, and that there are no rebates or "kickbacks" agreed to, or to be made to, any owner, general contracto-,
sub -contractor, or employee thereof, or any person, in connection with the work described below, or the job premises described
below.
231010-98
't 31�k`.i `.RaE�?y�f 1�n"«�ts ,4�'+ y, .s',,'r'.+-`i�'i?i4"7M'iRt".vn�r.'ti',;"''iA'.'ah�.rW'F.;'atc+,'!R►i�"�'^"'.
COACHELLA VALLEY VVATER DISTRICT
Ne `
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CASH RECEIPT DETAIL
Received From: bar � �� � ,; 1:1(4+
P -d— ed)
31'a�
Date:
1`'11 C�4I� bad. Or"
Address: ,.dr(c�Cs
a )
°�'_� 9
Account No.++_—�-^ Lot(s)
11
Service Address' "" �� 1 eco VUR[_
Tract
G.A. Code
`�•,
� ,/
'�'' �
fib
�Meter(s) �
$
d1oc ervlce'(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ Detector Check(s)
❑, MMeterSurcharge
Q606anitation Capacity Charge
_
U�
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee -Tract -
Fee -
❑ Plan Check• Fees Water I Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other
TOTAL
$
\ ` \ \ 1 ic1
Remarks: e1 'P�gAl i
❑Copy to:
Water Service
Cash
irlf,
3r..
{ �a.
4vv`4:
;• ...
Cashier
Check
Money
Order
Ay
•
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CV W D- 438 (11189 )
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A� OF THF
-
19.0
-an
vmon
i, This Certificate issued pursuant to the requirements of Section 306 of 'the Uniform Building,
Code certifying that at the time of issuance_ this structiure was in _compliance with the ,various • .
_.ordinances of,the City regulating building construction or use. • For the following: , ,
'F�; _, s . �•
53 -655 -Vallejo,
BUILDING ADDRESS
use Classification ,SFD Bldg. Permit No. 8049 ..
Group R3 "' Type' Construction VN Fire Zone Use Zone SR
owner of Building -Robert Charnley address 411 Calle Familia
�rZ.-
city Carlsbad, CA ~ 92672 '
,n By; Mark Harold
Dote: Tune 1-7, 1991 '
Building. Official- POST IN -A CONSVICUOUB PLACE
loll
^r .
Ik
A� OF THF
-
19.0
-an
vmon
i, This Certificate issued pursuant to the requirements of Section 306 of 'the Uniform Building,
Code certifying that at the time of issuance_ this structiure was in _compliance with the ,various • .
_.ordinances of,the City regulating building construction or use. • For the following: , ,
'F�; _, s . �•
53 -655 -Vallejo,
BUILDING ADDRESS
use Classification ,SFD Bldg. Permit No. 8049 ..
Group R3 "' Type' Construction VN Fire Zone Use Zone SR
owner of Building -Robert Charnley address 411 Calle Familia
�rZ.-
city Carlsbad, CA ~ 92672 '
,n By; Mark Harold
Dote: Tune 1-7, 1991 '
Building. Official- POST IN -A CONSVICUOUB PLACE