Loading...
04215 (MFD5)04215 P.O. BOX 1504 Building 78-035 Cobalt brit LA QUINTACCALIFORNIA92253 Address _ Owner Y. Boulevard i3ovel©rrent BUILDING:, TYPE CONST. A.P. Number OCC. GRP. 613-790^-008 Mailing Address 777 S,Maiin St. Suite 206 St., City Zip Tel. Orange 92686 714-547-9056 Legal Description Project Description Btiildines 10. plain 2. Contractor SH,LS'£s Address City Zip Tel. State Lic. & Classif. 462814 City Lic. # _ Sq. Ft. 922 No. M, No. Dw. Size Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. Es►�,�a�nra� i 1t1�,�+'� x�,�IRsA City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9,(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. .. —. , L.. rlS•;�.�`-`°,fes .t 1 .•--L-� 'a.-'-•L•,J i SIGNATURE DATE OWNER -BUILDER 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, after, 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). ❑ 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 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,Mech. provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year o/ completion, the owner -builder will have the burden o/ proving that he did not build or improve /or the purpose of sale.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Estimated Valuation C; $6% PERMIT _ AMOUNT Plan 'Chk. Dep. Plan Chk. Bal. l . b ` \ `� 4 4 Const. j �► Jd u V Electrical '�,'C, >� �, \44 • _ �D Plumbing �if� struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner o/ property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason S. M. 1. • Ji Grading Driveway Enc. Date Owner Infrastructure A'x X k. L'PdYc:P tf L ct3CC3 :3 • 1D 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 A,—"' r ,, ,r ! ❑ Copy is filed with the city. 0 Certified copy is hereby furnished. TOTAL +7'4 4 14. N } _ k "J. I ! REMARKS t CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE t (This section need not be completed i/ the permit Is for one hundred dollars ($100) valuation Of less.) I certify that in the performance of the work for which this permit is issued, I shall not i, ' 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 or the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) Side Setback from Property Line Lender's Name FINAL DATE Issued by: Validated by: INS.PECTO`�, ky' PEC TO Date Permit 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 Dale Mailing Address Validation: City, State, Zip WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE CONSTRUCTION ESTIMATE NO. ELECTRICALFEES' N0. PLUMBING FEES COLL. AREA �. PLUMB IST FL SO FT y S UNITS STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING YARD SPKLR SYSTEM 2ND FL SO FT. a �y FOUND. REINFej> ! �/ GAS (ROUGH) METER LOOP MOBILEHOME SVC. BAR SINK POR SO FT 7r GAS (FINAL) TEMP. POLE OUTLET`. ROOF DRAINS GAR 50. FT. 0POWER SERVICE FINAL INSP. BOND BEAM DRAINAGE PIPING CARP. SO FT. 0 GRADING cu. yd. $ plus x$ _$ LUMBER GR. FINAL INSP. �?/�i'Y .�� FRAMING �� Z a FINAL INSP. DRINKING FOUNTAIN WALL SO. FT. @ REMARKS: URINAL SO. FT. (# ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES - WATER SOFTENER VENT SYSTEM FAN EVARCCIOL HOOD SIGN WASH ER(AUTOXDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE",UNIT . WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM IKITCHEN 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 @ I W c SEWAGE DISPOSAL SO.FT.GAR r 3/Ac 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 8 AIR GOND. SOLAR SETBACK GROUND PLUMBING NDERGROUND A.C. UNIT COLL. AREA SLAB GRADEOUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE �y FOUND. REINFej> ! �/ GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. 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. �?/�i'Y .�� FRAMING �� Z a FINAL INSP. ROOFING VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR- GAR. FIREWALL LANG /l/tv MESH INSULATIONISOUND �� 6 FINISH GRADING FINAL INSPECTION CERT. OCC. ccrar^[ nisei REMARKS: - S SIGNATURESIINITIALS GARDEN WALL FINAL