003533 (BLCK)'Building.
Address 44-460 E. SUndoWn Crest
Mailing • . : U
Address 44-460 E. :3 am Czest
City Zip Tel.
T.a, nn i 2
Contractor
Address
44 -
P.O. BOX 1504 NO... '.0035013
78-105 CALLE ESTADO
JUINTA, CALIFORNIA 92253 .
'ix BUILDING: TYPE CONST. OCC: GRP:-
nit
'Dr. , A.P. Number La -Palms
Legal Description
Project Description TkTank. WAIT a
" City.....
Zip .
Tel.'
State Lic.
City
& Classif:..
Lic. #
Sq. Ft.
No. No. Dw.
Stories... Units
"Size,
Arch:, Engr.;
- Designer.
New ❑ Add ❑
Alter ❑ Repair ❑ ': Demolition ❑
Address
Tel.
CityZip
State
LIQENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions or Chapter 9 (commencing with Section"
7000) Division
of 3 of the Business and Professions Code, and my license Win full force and
effect.
.•, •.
,_ , _ _ - - , . .
- SIGNATURE - DATE
' OWNER•BUILDERDECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
. reason:.(Sec.-. 7031.5,Bustness and Professions Code: 'Any city or. county, which ,requires a
.PERMIT
AMOUNT
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 Ylie 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).-
_-: ❑.1,.as owner of the property, or my employees with wages. as their sole compensation,:will
- -
. Plan Chk. Dep..:
- -
Plan Ch"k. Bal. -,
'
COnSt.
4j � m
do the work, and the structure is not intended or'offered .for sale. (Sec., 7044, Buisness and
' P!Pfessions Code: The Contractor's License Law does not apply to an,owner ofpropertywho
Mech.
-
.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
- - • -
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.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-.
-struct the project. (Seca 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.) -
..O I am exempt under "Sec: Sec..B.
B. & P.C. for this reason �
. .
S.M.l.
-
Grading
Driveway Enc.
... .
Date'i +�`� ��Owner r `!1 i »+�/ •'<" 1
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that l have a certificate of consent'to self -insure; br.a certificate of,
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company .
O Copy is filed with.the city. .❑ Certified.copy is hereby furnished. . .
TOTAL
_
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed if the permit is for one hundred dollars ($100) • valuation
---oriess.). .. .. .. _
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.
t• 7 t, r x,F�S"�i r- a '.
.-
' 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 rorthwun -
comply with such provisions or this permit shall be deemed revoked.'
. ZONE: BY:
Minimurn-Setback Distances: "
Front Setback from Center Line
Rear Setback. from Rear. Prop.. Line
CONSTRUCTION LENDING AGENCY
hereby affirm that there is a�construction lending.agency for the performance of the '
work for which this permit is issued. (Sec._ 3 09 7, Civil code.)
�
Side Street Setback from Center Line
Side Setback from, Property Line
Lender's Name
FINAL DATE
• ... ..
Issued by:'
Validated by:
INSPECTOR _
Date 1!2 21/ 8P2rmlt
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
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. p $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT. p
WALL SQ. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
IKITCHEN 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
SQ. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE TLUMB. 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 APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
��BIOND BEAM / %/_ �i
l
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/IVITIALS
GARDEN WALL FINAL