13144 (PLBG)M1
P.O. BOX 1504 No. 13144
Building 53-150 Diaz LA QUINO
Aririracc TA CALIFORNIA 92253
Owner I
Sadler Electric
Address 1997 Friendship Drive
City Zip Tel.
El- Cajon, C 92020
Contractor
E®E Pl b,nq/xt,V. Stevenson
Address —
7410 Velardo Drive
City ip Tela
Palm Desert, Z& 92260 341-9224
State Lic. I City
& Classif. 602396 C-35 Lia # 2,329
Arcn., tngr., -
Designer
Address Tel. .
CityZip State
Lic. # .�
LI ENSED CONTRACTOR'S ECLARATIOIJ `I
I hereby by., the I �notcen ed r,•provis�o of Chapter 9 (co mencing with Section
7000) of Division 3 o Ire Burir�essjaynd Professi de- odd"my license is in full force and
't effect. f✓ / / i /�I' J r- mese Ate-., �4p;_
OWNER-BUIL'6ER 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, 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).
❑ 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 o/ 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.)
❑ 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 contractor(s) licensed pursuant to the Contractor's License Law.) -
O 1 am exempt under Sec. B. R P.C. for this reason
Date Owner
I
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
O Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundEed doll ($100) valuation
or less.) ♦ /'i
I certify that in the perfogm e o `�ik3�or-which t is arrgit is issy ri, I "shall not
employ any person in Vanmanner so as be'om subject to he w6i a s' •ompe ation
Lawsf of.Caliiornia. -� J
Date+0 qer
W77
—
NOME TO APP ICAAN. 1, afte aki ,t is CetWicate ofjmpt n iou s ould become
subject to the Workers' Compensation provisions of the Lar Code, you must forthwith
comply with such piovisions 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 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
City, State, Zip
LDING: TYPE CONST. OCC. GRP.:
.P. Number
egal Description
roject Description Super Hook-up
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
Issued by:_
Validated by:
Validation:
INSPECTOR
Perm
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑
Demolition ❑
Estimated Valuation
$i t 00o. 00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
%`
30.00
S.M.I.
Grading
Driveway Enc.
,
\
Infrastructure
\:J
i
TOTAL
t
30.00
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 Line
FINAL DATE
Issued by:_
Validated by:
Validation:
INSPECTOR
Perm
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
FOR. SO. FT. @
DUCTWORK
ROCK STORAGE
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. @
GAS (FINAL)
WALL SO. FT. @
DRINKING FOUNTAIN
SQ. FT. @
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property ta;valuation _.
-
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
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
SQ.FT.GAR @ 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 & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER
OUGH WIRING
DUCTWORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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
FINAL INSP.
ROOFING.
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION _ d_ 3 t
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
W.,444,34
Received From: SAD - L'G/ 2�G I "AIC Dater
A 199 % $-G�/�I�D.Sf-I1 SPL. .�7 �L CA 10 N
ddress. / /
Lots) 17
S� ISO
Service Address
❑ Meter(s)
❑ Service(s)
7a? --5
o
O Backflow(s)
O House Lateral (s)
O Detector Check(s)
❑ Meter Surcharge
' anitation Capacity Charge
O W.S.B.F.C.
O Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
O Plan Check Fees Water / Sewer -
Tract -
O Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other
Tract SG ; 8Glc 1.7
G.A. Code
TOTAL $ 17-2S,—
Remarks: 7-2S,Remarks: GKS'YG!'►1 ��j /,,{�/G L %�?/�/L �/`/l %�d�
OCopy to:
Cash
Check
Money
Order
D
Water Service
7a? --5
o
TOTAL $ 17-2S,—
Remarks: 7-2S,Remarks: GKS'YG!'►1 ��j /,,{�/G L %�?/�/L �/`/l %�d�
OCopy to:
Cash
Check
Money
Order
D
Water Service