003444 (BLCK)Building
Address
Mailing
Address
City
Pine Creek Development
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description Agit Ra*ifn.ixt wall.
Sqr'�Tcte
Rear Setback from Rear Prop. Line
City.
Zip
Tel.
1 hereby affirm that there is a construction lending agency for the performance of the
State Lic.
& Classif.
City
Lic. #
Sq. Ft. No.
Size Stories -
No. Dw.
Units '
Arch:, Engr.,._.
Designer
New ❑ Add ❑' Alter ❑
Repair ❑ . Demolition ❑
Address
Tel.
INSPECTOR
This is'a building permit when properly filled out, signed and validated, and is subject to
City
Zip
State
Lic. #
Issued by:
Date 1012 /R Permit
I agree to comply with all city and -County ordinances and state laws relating to building
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 11
7000) of Division 3 of the Business and Professions Code, and my license is in full force and -
effect.
construction, and hereby authorize representatives of . this city to enter the above.
mentioned property for inspection purposes.
SIGNATURE A. �,,. 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
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant /or such permit to file a signed statement that'he 1s licensed pursuant to
the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
sy Division'3 0/ the Business and Professions Code, or that. be Is eicempt Merelrom, and the basis
for the alleged exemption. Any violation o/ 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 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 o/ completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose o/ 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 o/ property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
.❑ 1 am exempt under Sec. B. & P.C. for this reason
Estimated Valuation h
�F � 00
-
PERMIT -•
- •r
-
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.r
Const.
Mech.
Electrical -
Plumbing -
S•M.I.
Grading
Driveway Enc.
Date Owner
Infrastructure
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. ❑ Certified copy is hereby furnished.
• _
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i/ the permit is for one hundred dollars ($100) valuation
or 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'
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate or 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. r
YStIVIHhSf\A r.r•,cFrJn alt, �1d'a�'� ;,/�_..t'r__n7 crti
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
1 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
Lender's Address
FINAL DATE
INSPECTOR
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.
Issued by:
Date 1012 /R Permit
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.
Validated by:
Signature of applicant Date
Mailing Address
Valldaticn:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SO. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. ®
GAS (FINAL)
WALL SQ. FT.
DRINKING FOUNTAIN
SQ. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax 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
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
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
MESH
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 PLUMB Nt
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC T
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$
o$
LUMBER GR.
FINAL INSP. Jf/�
FRAMING
FINAL INSP.
O
r
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING v
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL