14165 (SFD)P.O. BOX 1504
Building 78-105 79-'710 Iris Court LA QUINTACCALIFORNIAALLE DO
ddress 92253
OwneAoger snel-l.enberger & Associates
Mailin
Address
City Zip Tel.
( 17767
Contractor
Same
Address
City Zip Tel.
State Lic. City
& Classif. $ 489234 Lic. #
Arch.,-Engr:; Ccirl b Eas E"II— .neer
Designer R
A3dyj25 C 3:al.f.SWC37."th I)r. TZI-19) 328-7271
%tyatbedral C�:.t'reIp CA 92234 Lic.t#
LICEN(jiED CONTRACTOR'S DECLARATION
I hereby affirtnjhat :am icensed under provisions of Chapter 9 (commencingewith Section
000) of Divis/fon 3 of the Busrness�ariilj�Professions Code, and my license is`in full fort and
effect. i...�'f.ness ,o,! s �ll
SIGNATURE' ! r DATE
OWNER -BUILDER DECLARATION C
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness 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).
O 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
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. (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 confractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Corfipensation Insurance, or a certified copy thereof. (Sec. 3800, Labor.Code.)
Policyjf�o� Company
f7 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 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 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
No. 141.65
E
BUILDING: TYPE CONST. vs OCC: GRP. R3
A.P. Number 604-251-003
,Legal Description Lot 3 Tract 24208
Project Description Q_Fd 'Plan 6
Cactus K€ wer - 11 .
ti t3
Sq. Ft. ' 4 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter. ❑ Repair ❑ Demolition ❑
Estimated Valuation $102,613.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
5549.71
Const.
650.00
Mech.
62.00
Electrical
133.84
Plumbing
144.00
.S.M.I.
10.26
Grading
20.00
Driveway Enc.
Infrastructure
2.,308.80
Arts In Pu1 c Places
20.00
TOTAL
REMARKS
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 L ni e-.
FINAL DAl
Issued by:.
Validated t
Validation:
U
CONSTRUCTION ESTIMATE
NO: - • '- ELECTRICAL FEES
NO. PLUMBING FEES
;AST FL. Q. FT. ® $
UNITS
SLAB GRADE
I\ 11
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. ®
FORMS
SEWER OR SEPTI TA
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. S0. FT. ®
GAS (ROUGH)
ETER LOOP
'GAR. S0. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. S0. FT. ®
GROUT
WATER HEATER
. WALL S0. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SD FT. ®
WATER SYSTEM
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING '
NOTE: Not to be used as property tax valuation
ROOFING
/
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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, 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 ® 11/4 C
SEWAGE DISPOSAL
SO.FT.GAR Q 3/aC
HOUSE SEWER
61/0010
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
w.. . ..
STRUCTURE PLUMBING A ELECTRICAL, HEATING S AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTI TA
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
ETER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
INSP. Z]
GRADING
Cu. yd.
$ plus x$
=$
LUMBER GR.FINAL
FRAMING / 7 J
ROOFING
/
0-r,//
L"i / r`
0
J� (
-
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LA
'MESH
w'
INSULATIONISOUND
FINISH GRADING
61/0010
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
IN SI TLON CERTIFICATION
'1ms is to certify that insulation has been installed in confoiwnce with the
current energy regulation, CaliforAi.a Administrativer Code, Title 24 State of
California, in the building located at:
S I'M ADWM CACVjS_ F� ,SP -5 9 4 IM IA W WPA, CA
CEILMS
Batts: Type FpMpgM Manufacturer ups/c7MIW., lhicimess 12" R -Value �3B
Blom: Type Manufacturer Thickness R -Value
EXMIOR WALLS
Type K=facturer � Thickness 35/8 R -Value R-13
FLWRS Type YAnufacturer _ 'Thickness R -Value
General Contractor RD= SmELLENBEst= License I
By ITitle -- Date
Schmid 11mlatidn Contractors, Irks
License # 221517 C -Z
gyamw Title Vice President Date i2=21-94
ir
IN5iUTION =IFICkTION
This is to certify that insulation has been installed in conformance with the
current energy regulation, California Administrative Code, Title 2j State of
California, in the building located at:
SITE ADdB7ESS CNMA E[aM IA 95=-- CR
CEILINGS
Batts; Type VMmUAMYWnufacturer E/CCFNIW Thickness 12" R -Value R-36
Blown: Type Manufacturer 'Thickness � R -Value
EXTMIOP WALLS 5/
Type g iAs Manufacturer � Thicknsss 3 B R -Volas R -t 3
FiA0PS 'Type Manufacturer Thickness' R -Value
General Contractor License d
'Title Date
Schmid Insulation, Contractors, Inc. License 1 221517 C-2
• n
By 33% - R Title r vice Preside% t - Date t?�-94
'ACX