08559 (MISC)Building _.
Address ',I. ..
Owner.
Mailing x'
Address
City r Zip
Lit Of 92
Contractor
ress .`
T d6y
- •=L` ,
7 .,,P.O. BOX 1504 ' NO. r 085'9
t . t78 105 CALLE ESTADO r
_!.NTA._- LIFORNIA 92253 t.-.
-'h BUILDING:,_TYPE CONST. -OCC: GRP, -
I ar A.P. Number
Tel.
jaw Legal Description
Project Description
l�
14911 -of `1 -biith slump r
,City Zip Tel.:
324-8546
State Lica = City
& Classif. Lic: #
Arch.;'Engr:.
.'Designer
Address r Tel. -
City Zip' State -
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that,lram licensedyunder 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 :lI �- ,. ` til / -) r
SIGNATURE ftp--.- ,-;' 4- ? ..".w-^ — f., - ./ DATE
< '1
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 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 (S500). -
❑ I, as owner of,the property, cr 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 improvesr thereori=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 theburden
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 contractors) 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 -inure, 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 (8100) valuation
of less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ'any person in.ang manner so as to become subject to the Workers"Compensation
Laws of California.
Date • n4 er,`-
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 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
con struction,�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 '
'...•v(.t
Sq. Ft. No.!
Size Stories
New ❑ Add ❑ ;Alter ❑
No. Dw.
Units e',-•
Repair ❑ De-lmolition,❑,
REMARKS •- •*11KAP ill ��rr�t� y
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: ,
Estimated Valuation
PERMIT'
AMOUNT, -
Plan Chk. Dep.
Plan Chk.. Bal.
Const.•
Mech.
+
Electrical
Plumbing
S.M.I. z:
• �$
Grading
Driveway Enc.
Infrastructure ,�.
:• " .
TOTAL
REMARKS •- •*11KAP ill ��rr�t� y
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
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT.
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM [
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ic
HOUSE SEWER
FRAMING
FINAL INSP.
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
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
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 [
�O
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
I
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL