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9829 (SFD)' { P.O. BOX 1504 LMo. 9829 � C Building 78765 Grand Traverse LA QUINTA, CALIFORNIA92253 Address � -f� Owner M. J. Brock BUILDING: TYPE CONST. OCC: GRP. - Mailing Address 3380 Shelby Street A.P. Number Cit Zip Tel. Cit 93764 664-0973 Legal Description Brock Romes Contractor Project Description 2 Lot 52 SAME Address City Zip Tel.: State Lic: City & Classif. B412636 Lic. # 1890 sq. Ft. 2204 No. No. Dw. Size Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. i City Zip State ILic. # s LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Divlsion.3 ofthe Business and Professions Code,`and my licen_se,is in full force,and effect. I- Gv�r SIGNATURE +' •i - DATE OWNER•BUILDER DECLARATION Estimated Valuation T hereby affirm that I am exempt from t;e Contractor's License Law for the following reason: -(Sec.; 7031.5,Business and Professions 166,558.009 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 fila a signed statement that he Is licensed pursuant to PERMIT AMOUNT 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 Plan Chk. Dep. subjects the applicant to a civil penalty of not more than five hundred dollars (E500). Plan Chk. Bal. 'Sr 7 6 2 w 9 1 ❑ 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 Const. 874 . OU 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, Mech. �% provided that such improvements are not intended or offered for sale. d, however, the building ^ .00 . or improvement is sold within one year of completion, the owner -builder will have the burden Electrical 1 �G. •3 8 ' of proving that he did not build or improve for the purpose of sale.) ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 15 . 6 g6 . 50 struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law 11 does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading ❑ 1 am exempt under Sec. B. 8 P.C. for this reason Driveway Enc. Dale owner Infrastructure 3747.56 krt in Public 166.413 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 IB Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL 5775-91 C/ CERTIFICATE OF EXEMPTION FROM REMARKS 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 thg work for which this permit is issued, I shall not 311!}CZ4 S#rr 4 ft 7AX ^f IN -1 •a? employ any person in any manner so as to become subject to the Workers' Compensation , Laws of California. 1 t} rASH 1 `� � i ill. I W J 5775.9 f Date Owner 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 shall be deemed revoked. Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) - -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 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 Validation: y �� City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEf_S,, " 1S'r FL. SO. FT. ® $ UNITS COLL. AREA & CSLAB GRADE lv a ROUGH PLUMB. YARD SPKLR SYSTEM 2ND FL. SQ. FT. HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK FOR. SQ. FT. ® DUCT WORK ROCK STORAGE GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS METER LOOP TEMP. POLE HEATING (FINAL) DRAINAGE PIPING CAR P. Q. FT. GROUT WALL SQ. FT. DRINKING FOUNTAIN. SO FT ® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation =$ FLOOR DRAIN MECHANICAL FEES cju WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER VENTILATION 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, TEM/PERM 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. SQ. FT. RESID ® 1V4 c SEWAGE DISPOSAL SQ.FT.GAR ® V4c 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 PLUMBIN .� UNDERGROUND A.C. UNIT COLL. AREA & CSLAB GRADE lv a ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SE • TA ir?q ROUGH WIRING. DUCT WORK ROCK STORAGE WUND. REINF./). (G REINF. STEEL v (ROUGH) GAS (FINAL) ( METER LOOP TEMP. POLE HEATING (FINAL) OTHER APPJEQUIP. GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. _ _ -AL INSP. �/ •L � GRADING cu. yd. $ plus x$ =$ LUMBER GR. I VRAMING t ,ROOFING cju � c REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL 'I:THING _ MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO, PLUMBING FEES 1ST FL. SO. FT, UNITS LAB GRADE — 2ND FL. SO. FT. (rp BONDING YARD SPKLR SYSTEM STORAGE TANK MOBILEHOME SVC. BAR SINK POR. SO. FT. @ DUCT WORK ROCK STORAGE GAR. SO. FT. fe POWER OUTLET I ROOF DRAINS HEATING (FINAL) OTHER APP.JEQUIP. DRAINAGE PIPING CAR P. SO. T. 4 TEMP. POLE WALL SO. FT. GL GROUT DRINKING FOUNTAIN SO. FT. a FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE. Not to 5e used as property tax valuation _$ FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER 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 GAR. FIREWALL SQ. FT. Ifnc WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID (�o 1,- c SEWAGE DISPOSAL SO.FT.GAR ?-5c HOUSE SEWER ' GAS PIPING PERMIT FEE FINISH GRADING 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 LAB GRADE — ROUGH PLUMB, BONDING HEATING (ROUGH) STORAGE TANK FORMS n EWER OR SEPTIC it /j ROUGH WIRING DUCT WORK ROCK STORAGE OUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.JEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING CU. yd. g 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 (;ERT. OCC. FFNCF'':INAI INSPECIUM'J JIUNA I UMt511Nt 1 IALD r=JP.(?FN .'1J1 I PING