08806 (RPL)llcfwy�, 4 4 0 . ... : � .
Q" . �- � �D
P.O. BOX 1504 No, 08806
3uildjng 78-105 LA QUINTACCALIFORNIA92253
4ddressS5-�51� 7�c3>'xr_e�. iisll�v •
)wner
AAailing
kddress 42-600 Gook ,5t.. 42
amity Zip Tel.
:ontractor
taaress
;ity (Zip I Tel.
tate Lic. City
Classif. 288130 Lic. #
trch., Engr.,
)esigner
address I Tel.
pity( Zip I
State
Lic. #
a - LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed;undeftrovisions of Chapt (commenci
x000) of Division 3 of the Business and,Professions Code, and license is
We. t 4 tf ., ,1 i i o
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
aason: (Sec. 7031.5,Business and Professions Code: Any city or county whlch requires a
ermit to construct, alter, improve, demolish, or repair any structure, prior to its Issuance also
aqulres the applicant for such permit to file a signed statement that he is licensed pursuant to
ie provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
NJ' Sion 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
u the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
objects 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
o the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
rofessions Code: The Contractor's License Law does not apply to an owner of property who
wilds or improves thereon and who does such work himself or through his own employees,
rovided that such improvements are not intended or offered for sale. If, however, the building
r improvement is sold within one year of completion, the owner -builder will have the burden
f 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-
truct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
oes not apply to an owner of property who builds or improves thereon, and who contracts for
uch projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
1 I am exempt under Sec. B. ti P.C. for this reason
ate Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate,of consent to self -insure, or a certificate of
Norker's Compensation Insurance, or a certifiEd-copy thereof. (Sec. 3800, Labor Code.)
'olicy No.Company 41
❑ Copy is filed with the city. ❑of flied' 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
it less.)
I 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
.aws of California.
)ate Owner
IOTICE 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
:omply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
ork for which this permit is issued. (Sec. 3097, Civil Code.)
Bnder's Name
ender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
Kpiration if work thereunder is suspended for 180 days.
I certify that 1 have read this application and state that the above information is correct.
agree to comply with all city and county ordinances and state laws relating to building
Dnstruction, and hereby authorize representatives of this city to enter the above-.
ientioned property for inspection purposes.
ignature of applicant Date
lalling Address
ity, State, Zip
(BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
,Legal Description ma.� �. 2-165-144-1
Project
-165-144—
Project Description Phase 2X
COO amo Common Area & pool Pedestal
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
tstlmatea valuation
PERMIT f"
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
AMOUNT
TOTAL
30. ()i
REMARKS
i t 110TAL I W. ts+;
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 Permit
'Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES '"
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT.
WALL SQ. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
`
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
j 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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR. SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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 GOND. 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 APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
INAL INSP. fl—l'
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL