04702 (RPL)0`002
P.O..BOX 1504
Building78-105 CALLE ESTADO
960
Address 53 - villa LA QUINTACALIFORNIA 92253
.Owner
Wasterm 'ftl'Adero
BUILDING' TYPE CONST, OCC. GRP.
Mailing
Address A. P: Number .774-174-011. .
City Zip fel.
Legal Description
ol
Contractor Project DescriptionPo
—
G&" Roynolds
Address
69-481 -Sion Wa
CChity Zip tlwdrial -Citll� 922u
State Lic.
& Classif. -522876
Arch., Engr.,
Designer,
Tel
City
Lic. # Sq. Ft. NO.
"Size 'Stories
.1 New 0
D..
Units
Add.0 Alter 0 Repair 0 Demoliti,on.O.-
• Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (cpmmenci I ng with Section
7?OO)of Divisionof the Business and Professions Code, and my license is fn full force and
.3
. „,
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby' affirm that I am exempt from the Contractor's License Law for the following
'Code:
reason: (Sec. , 7031.5, Business and Professions Any city or county which requires a
permit to construct, after,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
PERMIT AMOUNT
the provisions of the. Contrattor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the 8us?6ess:a-,Pr6iessions Code, or that he Is exempt therefrom, and the basis
7031.5 'any lora
Plan Chk. Dep.
for the alleged exemption" -Any, -violation of Section by applicant permit
subjects the applicant to a , ciyif pepiltylof not more than five hundred dollars ($500).7
,
Plan Chk. Bai.
C3 1, 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
Const. 4Eli
Professions Code: The, Contractor's License Law does not apply to an owner of property who
builds or improvesthereon and who does such work himself or through his own employees,
Mech.
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
Electrical
• of proving that he did not build or improve for the purpose of sale.)
0 1, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing 14 a 00
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
S. M. 1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading . A
0 1 am exempt under Sec. B. & P.C. for this reason
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.C ompany
0 Copy is filed with the city. 0 Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM•
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hundred dollars (8100i valuation'vwlu
4 V
or less.)
V'k!io A. 1! W I
1 certify that in the performance of thp 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.
DateOwner
NOTICE TO APPLICANT., If, after- making, this Certificate of Exemption you should become
ZONE: BY:
subject to the *. Workers'_' Compensation provisions of the- Labor Code, you must forthwith
minimum Setback Distances:
comply with such provisions or this permit shallbe deemed revoked.
-M A,•
Front Setback from Center Line
0'- e
Rear Setback from Rear Prop. Line J
CONSTRUCTION LENDING AGENCY`
Setback fro"m Center Line - -
I herebi 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 Setba6k from Property Line
Lender's I Nam
Lender's . Address
F I NAL7 DATE 4 INSPECTOR
This is a building permit when properly filled out, signed and validated, and is�subjec I to
—-:-
/au
:- .- - ; ,
expiration it work thereunder is suspended for 180 days. t
I .
certify that I have read this application and state that the above Information is i;offec't.
'
Issued by '0' Date 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.
Y,
V� dated by:-% k
Signature of applicant -,'6ate—'
Mailing Address
validation.
-0 City, State,'Zip
A
WHITE K -�PPLI�A!Ni�'
4 FINANCE PINK GREEN - BUILDING,.GOLDENROD-- ASSESSOR'S OFFICE ,-HARD .COPY - FILE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO, PLUMBING FEES
IST FL SO F1 y $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB
YARD SPKLR SYSTEM
2ND FL SO FT. a
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
9
BAR SINK
POR SO FT. Q!
DUCT WORK
ROCK STORAGE
GAR SO. FT. a
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO FT. f(1
GAS (FINAL)
TEMP. POLE
WALL SO. FT. Q
DRINKING FOUNTAIN
SO. FT. (a
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
plu5 x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTORDISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
y
fX_(7J�
Lill(/ h�Y
`/2�
e
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.
SO. FT. ® c
BATH TUB
SPARK ARRESTOR,
SO. FT. c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID I'A c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR rg 3i.c
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
INSULATION/SOUND
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 8 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.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plu5 x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
y
fX_(7J�
Lill(/ h�Y
`/2�
e
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 7d