05229 (SFD)i -tyl 4
i TA
P.O. BOX 1504
Building - OTACCALIFORNIA 92253
Address r4$ .�Zt.� '�i$$ �i�.$�8f1 LA QUIN
Owner
Mailing
Address 9010 Corbin Ave-. , Suite 3
City Zip Tel.
Northridge 1 91324 1818-349-5894
Address
e3rt I 92260
State Lic. I City
& Classif. 195333 Lic. #
Arch, Engr.,
Designer
Address I Tel.
city I Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebraff-um that I am licensed under provisions of Chapter 9 (commencing with Section
70001 of DYaan 3 of the Busine/ss d Professions -Code, and my license is in full force and
effeGT. �,i.: .1. r,.+✓.e^J" 1 %.F
d' V ' DAT5�
-�� 1 OWNER -BUILDER DECLARATION J f
1 hereby affipn that I am exempt from the Contractor's License Law for the following
reason: Isom 7031.5,Busihess and professions Coder Any city or county which requires a
pen* fo construct, alter, improve, demolish, or repair any structure, prior to its issuance also
regrittes Ore appira I for such permit to file a signed statement that he is licensed pursuant to
Me pvavisimrs of the Contractor's License Law, Chapter 9 (commenting with Section 7000) of
Lhisbn 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
far the a- ged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the appira I to a avi penally of not more than rive hundred dollars ($500).
❑ 1, 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
FhOessiim6 Code- The Contractors License Law does not apply to an owner of property who
brads or improves (hereon and who does such work himself or through his own employees,
provided that such improvements are riot intended or offered for sale. If, however, the building
o ilprove mer( is said ww* one year of completion, the owner -builder will have the burden
dpr" Mahe rfid not buil or irprove for the purpose of sale.)
❑ k 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.
dors not apply to arm owner of property who builds or improves thereon, and who contracts for
such, iecI with a contractors) icensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec w. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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 Nri Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(n* sedim need not be completed ff the permit is for one hundred dollars ($100) valuation
oriels)
1 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
nate Owner
NOTICE 70 APPLICANT. lt, after making this Certificate of Exemption you should become
subject m the Mlmkers' Compensation provisions of the Labor Code, you must forthwith
amply sr� such provisims or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of the
wok forwhidx this permit is issued. (Sec. 3097, Civil Code.)
Lenders Name
Lendefs Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
1 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
constructim and hereby authorize representatives of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
(Mailing Addtrss
C ty, State, urn
No.
BUILDING: TYPE..CONST. OCC: GRP.
05229
'.Number 31% ?14_Vq.1
Sal Description
eject Description! Plat! 6R, Lot 43
Sq. Ft. 2��9 No. No. Dw.
Sizer 2009". Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$104,139
PERMIT
BY:
AMOUNT
Plan Chk. Dep.
C �1 SA n.t
Front Setback from Center Line
Plan Chk. Bal.
Rear Setback.from Rear Prop. Line
lip r C
Const.
cy
Mech.
FINAL DATE
3. fi}d
Electrical
12/30/38
I 75:01
Plumbing
i
86.00,
S.M.I.
Validation:
Grading
Driveway Enc.
'
Infrastructure
1,343.13
TOTAL
$3.363.81
REMARKS
—f4f o t. FLi �V
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
12/30/38
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADEZIPROUGH
PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SQ. FT.
FINAL INSP.
WALL SQ. Ff.
WATER SYSTEM
DRINKING FOUNTAIN.
GRADING
cu. yd.
$ plus x$
_$
URINAL
Sp. FT.
FINAL INSP.
FRAMING L -f
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
ILAUNDRYTRAY
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.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
FINAL INSPECTION
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
ROUND PLUMBIN9
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADEZIPROUGH
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 L -f
INAL INSP.
ROOFING �' /v/
w
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 4 -JOA/ y/�i%
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL