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426190 (GRES)PERMIT NO. DEPARTMENT OF BUILDING & SAFETY DIST 426190 COUNTY OF RIVERSIDE FIELD I I CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. @ UNITS 'p Z 2ND. Fl. SQ. FT. @ Valuation y (,a i Is 7j6 _—, Dote �! '`•! '.— 0 / YARD SPKLR SYSTEM, POR. SQ. FT. @ F MOBILEHOME SVC. Micro Film Fee BAR SINK a �.v r POWER OUTLET •t� ROOF DRAINS GAR. SQ. FT. @ Mech. Fee Dial $ /� PI. Ck. Fee § 'Y" � Set Backs - CAR P. SQ. FT. @ Construction Fee Dbl $ �Qrf.Legal Description �. C - //v�yy /- 4^ IF V �(� Y' V/ DRAINAGE PIPING WALL SQ. FT. @ ZoneRetrictions Group Type DRINKING FOUNTAIN SQ. FT. @ Dbl $ Bond Amt. $ URINAL ESTIMATED CONSTRUCTION VALUATION Is �R 7 /cJ, '{ Final Dote Inspector inif_ . WATER PIPING NOTE: Not to be used as property tax valuation $ SWIM POOL, PVT Const. Lender FLOOR DRAIN MECHANICAL FEES' Supplimental Permit Numbers / SWIM POOL, COMM Mileage Fee § Mileage e WATER SOFTENER VENT SYSTEM FAN EVAP. COOL HOOD G SIGN WASHER (AUTO)(DISH) y, APPLIANCE DRYER F Tel. Zip GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED Add ss i / LAUNDRY TRAY AIR HANDLING UNIT CFM M.O. N.G,0 Cash Check IDLE METER KITCF cN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC LiceJnse# WATER CLOSET COMPRESSOR HP POLE,TEMP/PERM Address LAVATORY HEATING SYSTEM FORCED GRAVITY Ci Zip AMPERES SERV ENT SHOWER 1 BOILER B.T.U. -SQ. FT. @ t BATH TUB SQ. FT. @ t WATER HEATER SQ. FT. RESID @ 1114 c SEWAGE DISPOSAL SQ. FT. GAR @ 3%c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL. TOTAL FEFtiS,,r MOB. HM. FEE MICRO FEE MECH. EE PL. CI5.�f.EE CONjk.!E ELECT. FE SMI FEE FEE PLUMB. FEE PERMIT NO. 426190 Job Address _ s '- •- Space 'p Owner .' cm IF- Community }�1 �7 / % G/ ., �V' -r Valuation y (,a i Is 7j6 _—, Dote �! '`•! '.— 0 / Dist. // Off. ` ry ! F MH.Permit Fee $ Micro Film Fee Cop $ Use of Permit :i 4�- �.ti. ' �' 44 /i`!k-(/ •t� Parcel No.Use/Case 7 �7 �� '-C� �.a`,% No. I Ck. By Mech. Fee Dial $ /� PI. Ck. Fee § 'Y" � Set Backs - Lot Size Construction Fee Dbl $ �Qrf.Legal Description �. C - //v�yy /- 4^ IF V �(� Y' V/ F IS/, �y S ._ R 0 Electrical Fee Dbl $ ZoneRetrictions Group Type SMI Fee $ Plumbing Fee Dbl $ Bond Amt. $ Plan No. PI a her Final Dote Inspector inif_ . Sp. Insp. Fee $ Demol. Fee $ Const. Lender Branch Supplimental Permit Numbers / Fee § Mileage Fee § Mileage e Address City Zip Witness Fee $ Reinsp. Fee g Owner/Agent Tel. Zip Total Fees $ / - Add ss i / City Zip M.O. N.G,0 Cash Check Received by a (C/y«'r,'�v c I a, . \. i�.1 l _.�'�%C t.sj Tel. (� LiceJnse# Trees requ �c [r'i� Sewage System Address Ci Zip T LL P THIS'PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WO verified by: �._ Sewer District FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID. _ee�i I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA. I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN 'Form 284-208 (Rev.8/78) ©s ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. ti-wrr' � ��.w.M.+L::aoi.(S`.w1.way:wai..: u�.Lcorcc^ '{'.cn `2:+f- •. ......_c..ri.r...-wlnu..�.:L.w.:.:.4.n....:.N �._.,;�r:.n...L�.YL-._v. �.... ............4 _. a ......... _...... ,. _.a ... _wi:._ -... �. .`M _. ..t NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 2 Set Back Figs & Frms ' /� '� 4/ 33 34 Ventilation System Plenums & Ducts 2A Slab Grade s,yz ,-- 35 Furnace Comport. 3 Steel 36 Inlets & Outlets 4 Grout Blocks 37 Combustion Air 5 Bond Beams 38 Compressor 6 Roof Deck 39 Appl. Clearance 7 Framing 40 Fire Damper 8 Vents 41 Smoke Detection Device 9 Garage Fire Wall 42 Commercial Hood 10 Fireplace P. L. 43 Final IDA Fireplace T. 0. P' ADDITIONAL INFORMATION - SEWAGE SYSTEM SIZE 3. LOCATION 11 Exterior Loth 12 Internal Lath 12A Drywall 13 Finish Grade INSULATION Thick R Volue 7A Walls (Batts) b �(� 1 12B Ceiling (Batts) 12C Ceiling (Blown) _ 14 Final PLUMBING APPROVALS 15 Ground Plumb, 16 Water Piping 17 Rough Plumb 18 Vents 19 Sewage Disposal 20 Sewer 21 Water Heater 22 Water Softener 23 Water Service 24 Gas Test 25 Final Tank Pit ' L.Line REAR OF PROPERTY LINE ELECTRICAL APPROVALS PSL ;` + A P/ .i " 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final STREET NAME DEPARTMENT OF BUILDING AND SAFETY APPLICATION CERTIFICATE COUNTY OF RIVERSIDE PERMIT H Effective July1, 1980, Chapter 1301, Section 19825,of the Nlalth and Safety Code requires the execu- tion of the following applicable declarations prior to the issuance of a building permit. Please print 'or type .and sigmbelow: 1 1, LICENSED CONTRACTORS 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. License ClssLicense No. 2,./(oho-3y Date I/ Z4 / Contractor CV K]j 05-i iL Q OWNER -BUILDER DECLARATION I hereby affirm that I amexempt from the Contractor's License Law for the following reasons: [� 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. If I sell within one- year of completion, I understand I will have the burden of proving I did•not build or improve for.the purpose of sale (Sec. 7O31.5;'B.&P.C.). [� I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, B.&P.C.). [::] I am exempt under Section , B:&P.C. for this reason: Date Owner ® WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure, or a Certificate of Workers'. Compensation Insurance, ora certified copy thereof'(Sec. 3800, Lab.. Code). Policy No. W N J;( ,3yCY4y Insurance j=vevA.pw�— Q Certified copy is hereby furnished. /� WC Certified copy is filed with the County o�•f-Riverrs4ide �epahtment of Building and Safety. Date ��/ga�8 Applicant CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if permit valuation is for $100.00 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. I further understand that if after making this Certificate of Exemption, I should become subject to the Workers' Compensation provisions of the labor code, I must forthwith comply with such provisions or this ,permit shall be deemed revoked. Date Applicant 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, Civ. Code). Lender's Name Lender's Address DIVISION OF INDUSTRIAL -SAFETY PERMIT CERTIFICATION rl I hereby certify that no excavation five (5) or more feet in depth into which a person is re- quired to descend, will be made i6 connection with work authorized by this permit, and that no building, structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8, C.A.C.) Q As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from that division. �] Division of Industrial Safety Permit No. Date Applicant CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY I certify I have read this application and state that the information given is correct. I agree to comply with all state lis and county ordinances relating to building construction, and authorize a representative of f6e County of Riverside, Department of Building and Safety to enter upon the pro- perty fqf7which I ro- pertyfor,whichI ha/46`pplied for this permit for the purpose of makinvinppections. ignature ojf pp, icing' gen/Z Date wAI � �5 Print Appl cant/ gent Name 284-2000 7/80 NOTICE: THIS IS NOT A BUILDING PERMIT APPLICATION TO CONSTRUCT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF RIVERSIDE Owner YM_"if✓ IV,4e Addres 53^ 11,73 (71Az- City 4,4 tw fti . - Architect ✓lQf �% f1 Address City___ DISTRICT �f Permit No Contractor L- V$41'5 Address_ City_ Z4 IK4A Phone— "I hone W 1 (we) the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if Curb and Gutter, and z Paving, and/or Dedication of right of way is required by the County of Riverside, the Riverside County Department of Building and Safety 3 shall not make a Final Inspection until said requirements have been met. 1 am also aware that no work is to be done within the County R/W O without an encroachment permit. NOW, therefore, it is agreed that 1 (we) will not occupy said property and will not cause said property be oc �Plodu ilwe) e complied with all laws of he County of Riverside and the State of California governing said property. DATE !1 SIGNATURE OF OWNER AND/OR AGENT Approval by Signature from the Following Departments Listed Below Must Be Obtained Prior to the Issuing of a Construction Permit. 1 SPACE N0, USE OF STRUCTURE JOB ADDRESS '�qUe, 7,/_* / ` �Q— SINGLE FAMILY � DUPLEX LE AL SCR ION OF PROPERTY / Z H J°� � — APARTMENTS AGRIC. N Q c—TJ COMMERCIAL INDUSTRIAL L� j '^ COMMUNITY C NO. OF SUBMITTED PLANS ---- USE OF PERMIT Q Ci 42 ALTERATIONS ❑ 4 CASE N0. c Z - NO. OF P KING SPACES REQUIREDNO. OF BUILDINGS NOW EXIST -WG — ZONE,- I SETBACKS: FRONTl�i SIDE/3 le m GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE � SETBACK_DRlI ANCE OF FEET REQUIRED ON — STRE� — DATE SIGNATURE OF LAND USE OFFICIAL \��_—�--'— N DEDICATION REQUIRED: YES ❑ NOrtf NO. OF FEET___ W CURB AND GUTTER REQUIRED: YES ❑ NO ry f —STREET i F : W CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES, ❑ NO ❑ HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FO DRIVEWAY AND STREET CIMPROVEMENT YESNO ❑ / °C DATE ��j� SIGNATURE OF ROAD DEPT. OFFICIAL = SWIMMING POOLS PUBLIC QW SEWAGE DISPOSAL _ _ FOOD ESTABLISHMENT WATER POLLUTION REMARKS �n FLOOD CONTROL — z AIR POLLUTION W 1 DIV OF HWY c a _ YOUR PROPERTY MAY BE SUBJECT TO d M, FLOOD. RIVERSIDE COUNTY ASSUMES NO RESPONSIBILITY IN EVENT OF FLOOD. 264 199 9/74 CANARY—FILE, PINK—APPLICANT BUILDING PERMIT PERMIT NO. 426190 DEPARTMENTOF BUILDING & SAFETY DST] COUNTY OF RIVERSIDE FIELD OFFICE i/ CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. @ $ UNITS r13 `.r"" Date �M/'✓�� 2ND. FL. SQ. FT. @ Off. „r.� 144 MH.Permit Fee $ YARD SPKLR SYSTEM POR. SQ. FT. @ Use Permit +' MOBILEHOME SVC. Use/Case No. 1/9 BAR SINK _ -7 I E% POWER OUTLET Lot Size ROOF DRAINS GAR. SQ. FT. @ ` F +.♦ S S -... R Electrical Fee Dbl E Zone Restrictions CAR P. SQ. FT. @ Type SMI Fee $ Plumbing Fee DRAINAGE PIPING WALL SQ. FT. @ Plan No. Pla cker y Final DateInspector s S, DRINKING FOUNTAIN SQ. FT. @ rip Demol. Fee E URINAL ESTIMATED CONSTRUCTION VALUATION $ •g G Mileage Fee E WATER PIPING NOTE: Not to be used as property tax valuation Reinsp. Fee SWIM POOL, PVT Owner/Agent FLOOR DRAIN MECHANICAL FEES SWIM POOL, COMM E 5 WATER SOFTENER VENT SYSTEM FAN EVAP. COOL HOOD City Zip SIGN Received by WASHER (AUTO)(DISH) APPLIANCE DRYER Lice/nsre# Trees requir GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED AddressZip we-4a LAUNDRY TRAY AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE,TEMP/PERM LAVATORY L HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER t BOILER B.T.U. SQ. FT. @ C BATH TUB f SQ. FT. @ C WATER HEATER SQ. FT. RESID @1''c SEWAGE DISPOSAL SQ. FT. GAR @ 1%C s HOUSE SEWER GAS PIPING PERMIT FEE (% PERMIT FEE (, PERMIT FEE DBL. TOTAL fifi J MOB. HM. FEL MICRO FEE MECH. EE C E ELECT. FE EJj SMI FEE FEE PLUMB. FEE [/PL. (CON PERMIT NO. 1426190 Job Address Space 'p C3 - z .,ve. 25,E 3 Owner /y��. (_ 4LJ Co ,unit + �9vl.•� /� j`n T- Vol �(ayI'�n E [/ �jG> r13 `.r"" Date �M/'✓�� Dist.t.! 11 Off. „r.� 144 MH.Permit Fee $ Micro Film Fee Cop E Use Permit +' Parcel No. 71 -6 Z..p Use/Case No. 1/9 Ck. By Mech. Fee Dbl E PI. Ck. Fee E Set Backs Lot Size �+it Construction Fee Dbl E / T Legal Description �'^ %syr.• \ /'f�� %%�} ` F +.♦ S S -... R Electrical Fee Dbl E Zone Restrictions Group`s Type SMI Fee $ Plumbing Fee Dbl E Bond Amt. E Plan No. Pla cker y Final DateInspector s S, Unit ' Sp. Insp. Fee j Demol. Fee E Const. Lender Branch Supplimental Permit Numbers Regist, Fee E Mileage Fee E Address City Zip Witness Fee E Reinsp. Fee E Owner/Agent Tel. Zip Total Fees E 5 -Add ss ` ' City Zip M.O. Cash Check Received by C ctorTel. L/���/J/f Lice/nsre# Trees requir Sewage System AddressZip we-4a .T LL P Sewer District ".Form 284-208 (Rev.8/78) ©s THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK verified by: FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID. I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA. I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. 9 z 0 U W U) CID z O U W U) Q W cc _; r_ ,, 1 C' * ` .�>n '`I'4it� �' 31`. ,a. .� �' ... .r 1+' �''�' `. .. .. -' ;'^'3iet: •�.- 'i.; ,'�'�" COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH ENVIRONMENTAL HEALTH SERVICES DIVISION - - PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM Applicant: Suut phis form with four copies of , scaled plot plan (1-20 scale) drawn to County specifications required on the attached check list. Anon -refundable filing fee of $40 i equired when the application is submitted. Check must be made payable to the County of Riverside. � � 1-7 Building Department Application Log # .t\fame (Ovine . Agenl. Contractof'Elc.) Mailing Address C ty` i Zip C,v Telephone ifob Progeny Address — _'%1 _ 'Cny�r.-e _unny- r 'Le al Description of�f PPfIroperly (Lot. PM. Tq 21-1-1 *Assessor's Parcel No �- *' aier Agc C? `J Lot Size Use of Permr],_ 94Ja-h�ng Case M O ZO SFD. MH Site Preparation Etc 5,470 Certification of Existing S.D. System required WOCB Clearance required. Soils feasibility report required. Special feasibility boring report required. Detailed contour plot plans required. Staff Specialist approval required. 'The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE ❑ Yes llal5NX •. ❑ Yes Je No� ❑ Yes El No ❑ Yes LTJ '6 ❑ Yes ?N ❑ Yes o Soils/boring repo by e -7 -,Soils Map Page O/� Soil Type ' Approved by Type of System: ❑ Existing ®N' ew ❑ Additional ❑ Replacement (2) L �ach line sq. ft. Sidewall allowance (Bottoriiltrench area) ft. rock/ Sq. Ft. per running ft. (B¢N/A Leach lines/bed-special design for slope: (3) Pit Diameter Applicable r N/A Overburden factor KIM � No.. of Bedrooms f `�' 4-ey V Project N Initial Date Lot Inspection uate Date (1) Septic Tank Soil Rate equired "� • /om Gals. 7/ /., Install Lines) Ft. Long, U Leach bed Sq. Ftwi a mthim inches Ft. of bbottom**.., rock below drain lines area No. Pits Pit BI Seepage Pit total depth "'I l/ Max. allowable depth TO This application i§. roved enied for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements set forth in Section Bab"ove. A building permit is�er)�e�ceessary for the installation of the above -designed Sy tem. U (1) Septic tank and sewer lines must be 5 I'l�om any wellsr%/ ' -� (2. Leach lines must be 100' min. from any wells including exp .sio area iTO (3 Seepage pits must be 150' -fn. from any wells including expansion area �� Signature of Health Official /� ' y�� '^ F✓ Y/' ' RECEIPT NO_ (a tfV Issued by -% - Dat / % c.2 l� District: ❑ Riverside O�1n Ido ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe Distribution: WHITE -Office file YELLOW -Applicant PINK -Bldg. Dept. GOLDENROD -Pending File DOH -SAN -122 (Rev. 4/88) ?7 1 Buena Engineers, Inc. 79-811 Country Club Drive, Suite 4 Bermuda Dunes, CA. 92201 • (619) 345-1588 / 328-9131 Client Client Address Client Phone DATE TEST LOCATION w. O J JOB NO. 49,98.5-- 885 - n FIELD TESTING REFERENCE CURVE MOISTURE CONTENT % PROJECT MAXIMUM DRY DENSITY % MAXIMUM DRY DENSITY lbs./cu. ft. 53 L/p ; A ud ati Pett oua�J,-� i LOjCATION .� r- i�, �'" I CONTRACTOR OWNER WEATHER TEMP. o at AM dea, 113(CCd 0 a PM PRESENT AT SITE TEST NUMBER TEST LOCATION w. O J LOT NO. ELEVATION FIELD TESTING REFERENCE CURVE MOISTURE CONTENT % DRY DENSITY IbsJCu: ft. ' MAXIMUM DRY DENSITY % MAXIMUM DRY DENSITY lbs./cu. ft. OPTIMUM MOISTURE CONTENT % Pett oua�J,-� i .� r- i�, �'" to. ocr r a r �. F.. .rt _.y�.� ,�7. .�. .�rt; k ..� —•.; v"�..^ -:�' 4• -�`: ,.� �_ . -y. -'-tr–fit A J•, �'�.. _ f REMARKS: A (tto.f Q u., ln6s" le . -TLC) 4"S4s Iv\ 1,1Me • 014 oce, V Q✓ L,1.4cnqyl vpcNti . ev- l (4n,l7.1 v eqj, Ste• (r � � w.0 P.n •'{ S �., vH AA D q z. _----.--- ; Naas GE 10-PCf 4(kP �tuco,� �vt5 QfFp ct�- or Gc�qc1ue `fie 90,70 YK,KtMuvtl, t Z 8 91 CLIENT REPRESENTATIVE SIGNATURE �1PSUCtt. \e�� i� VJGtb^d MQtY�/. h x4 i FIELD REPORT TECHNICIANS SIGNATURE 1 j q2-2-, P.O. BOX 1504 APPLICATION ONLY Building�-�� r1� / 7&105 CALLS Address / i� .7f LA QUINTA, CALIFORNIAORNIA 92253 'Owner Mailing Address ntractor Address WING: TYPE CONST. OCC. GRP. A.P. Number �% % �% /�c/� -- 0 Z / Tel. v O % ri /Li L G � ?,c f � GY,�/ Legal Description Project Description % L Tel.. State Lic. '.�+wl city . . & Classif. # Arch., Engr., I Designer Address Tel. City (Zip (State I 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. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that 1 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, Bulsness 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.) ' ❑ 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. & 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 Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ Copy is filed with the.city. ❑ 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, 1 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. 1 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 BUILDING DIVISION ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side StreeJt�-ISetback from Center Line Side Setback from Property Line FINAL DATE ,e!SPECTOR Issued by: Date Permit Validated by - Validation: zz Sq. Ft. /� =7 Size No. No. Dw. St les Units New Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation / tt PERMIT AMOUNT Plan Chk. Dep. a p 'D Plan Chk. Bal. Const. di Mech. p Electrical Plumbing O Uv S.M.I. S %/ Grading a2 Driveway Enc. Infrastructure 20 JAr, r r G JZ 41- w/ ? n .a TOTAL. REMARKS 4h r•Ac'L1 3 TnTQI t —w')'75 nn- ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side StreeJt�-ISetback from Center Line Side Setback from Property Line FINAL DATE ,e!SPECTOR Issued by: Date Permit Validated by - Validation: CONSTRUCTION ESTIMATE GROUND PLUMBING UNDERGROUND NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ AgaUNITS BONDING HEATING (ROUGH) STORAGE TANK FORMS 2ND FL. SQ. FT. ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. YARD SPKLR SYSTEM METER LOOP HEATING (FINAL) OTHER APP.IEQUIP. MOBILEHOME SVC. GAS (FINAL) BAR SINK POR. SQ. FT. ® GROUT WATER HEATER SERVICE FINAL INSP. GAR. ` SO. FT. ® 9121va WATER SYSTEM POWER OUTLET GRADING cu. yd. $ plus x$ ROOF DRAINS LUMBER GR. FINAL INSP. FRAMING FINAL INSP. DRAINAGE PIPING CAR P. SQ. FT. ® REMARKS: WALL �� SO. FT. ® `l O DRINKING FOUNTAIN SQ. FT. FIREPLACE URINAL ESTIMATED CONSTRUCTION VALUATION $ 224 ,( /0 GAR. FIREWALL WATER PIPING NOTE: Not to be used as property tax valuation LATHING FLOOR DRAIN MECHANICAL FEES INSULATIONISOUND WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER CERT. OCC. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED INSPECTOR'S SIGNATURESIINITIALS. LAUNDRYTRAY AIR HANDLING UNIT CFM 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 S SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1I c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING PERMIT FEE MPERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE-j CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE v 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.IEQUIP. 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 INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS. GARDEN WALL FINAL