15616 (PAT)RtcK �ShEA
P.O. BOX 1504
6ilding78-495 CALLETAMPICO
daress 44-670 N. Harland Drive LA..OUiNTA,CALIFORNIA 92253
fess 8144 E. Kaiser Blvd.
Zip
elm Dills 1 92808
Contractor
. same as above
Address
WING: TYPE CONST.
lA.P. Number
No. 15616
OCC: GRP.
714--202-5800 Legal Description -
Project Description 120 sq. ft. Open Lattice Ratio
State Lic. City
& Classif.. 2.93954 Lic. # 1612
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOWS.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. jr_�11- -
-' OWNER diglDgR DECLARATION
;I.liejeby affir)n that I am exempt froib the Contractors License Law for the following
reason:' (Sec. 7031.5; ess and Professions Code: Any city or county which requires a
_ penri7t'to:'consUucr.. after. improve, demolish. or repair any structure, prior to Its issuance also
statement
the provislone of the Cmbacfor's License Law, Chapter 9 with Section 7000) of
Division 3 of the Business and Profesalans Code, or that. he Is. exempt therefrom, and'the basis
for the swaged .exenyotipn- Any vtopafbn of Section 7031.5 by any applicant for a permit
-subjects the applicant to a c/vft pence not more than 8ve hundred dollars ($500).
❑ I„as owner of the property, or my employees with wages as theiraole compensation, will
do the wodc and the structure is not Intended or offered for eels. (Sec. 7014, Bursness grid
Proleas/ona Qode: The Contactors LJcarmse.Law rubes net appry to en owner of property„who
builds or Improves f/iereon. sed .wino does such work hbinaeft or through his own empbyees,
provided that such trnprorerrnernts are not idended or offered tor.s�le. H, however, the.bulldlnp
or inproverrrent b solo wftM ane year o/_ cmnpietkm, the owner-buNder wlp have Me .burden
of proving that he'dld not buAd or improve for the purpose of safe.)
O 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. ,7044, Bushess and %Prolessions, Code: The Contractor's License Law
does not, appiy to; an, owner of property who bunds or approves thereon, and who contracts for
such projects with cantractor(s) Acensed pursuant to the Contractor's License Law.) -
O 1 am exempt under Sec. R• 8 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm .that 1 hakwa certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor, Code.) -
Policy No Company
C `Copy is filed with the city. O.Certined copy is hereby furnished..
CERTIFICATE OF. EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE :
(This section need not be completed M the permf Is for one hundred dollars ($100) valuation
or less:)
I certify that In the performance of-thp work for which this permit, Is issued, I, shall not
ifomia
employ any ppeereon in. any manner so as to become subjset to the. Workers' Compensation
Laws of l;al
Date Owner
NOTICE TO APPLICANT: It after making this Certificate of Exemption you should become
subject to, the- Workers' Campensaflon provisions of M e Labor code, you must forthwith
comply with such provisions or Lists permit shall be deemed revoked. - -
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS (6100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST, AND
ATTORNEY'S FEES.
This'is a building, permit when propeAyfilled out, signed and validated, and Is subject to
expiration If work thereunder. is suspended for 180 days.
L certify that l have read this.application and state that the,above information Is correct.
1 agree to comply wlth.allcityy and county ordinances and state laws relating to building
construction, and hereby 21horize representattves sof this city to .enter the above..
mentioned property for Inspection'puiposes.
Signature of applicant— Date
Meiling Addres
City, State, ZI
REMARKS.
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:
Validated by:
I•
1'1UU J +:t. IJJJ
Sq. Ft. No:,
Size 120 -Stories
No. Dw.
Units
Newel Add ❑ Alter ❑
Repair ❑ Demolition-❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
29-25
Const.
Mech.
Electrical
Plumbing
S.M.IL
Grading
Driveway Enc.
Infrastructure
TOTAL
74 _ 75
REMARKS.
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:
Validated by:
I•
1'1UU J +:t. IJJJ
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SQ. FT..® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO..FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS rt
CARP. SO. FT. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.. ®.
OTHER APPJEQUIP..
DRINKING FOUNTAIN
SQ FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE:, Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
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, TEMIPERM
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.
SO. FT.,RESID'® 1'Ai c
SEWAGE DISPOSAL
GAR. FIREWALL
SO:FT:GAR ® 314c
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
MESH
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
DUCTWORK
ROCK'STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP..
iREINF,. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu..yd.
$ plus zt
=_
LUMBER GR.
FINAL INSP.
'FRAMING
FINAL INSP.
ROOFING
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
matter Ute a foody
X--Lp-p—aN 24,
L A(;.c loVc-�'_
seetl:WOM§ ws•► -
.1 ax to sw�
pem4er p£Ae�`
flse
1f
. .tier s'°e - -- --- • - SIA}
Salk awftat bete 11eler
-•ptlfy Neof;l% s fAeotAlee at Open Lott its
Y'sed ogle Straps
Irst armil ' van
4-16 a able se halt
^nf
Past o"�tl1L_0�
enroll bL6tL JZ _v
o
u., 6'a• fpt•
rte.: IN; u
2000 Irs.i. flQiaste or 'Z
it � Ilia. 1Tti12•
ltsa iss1!
�311ra5- 1s6 street sets stab at li- e.g. 1141« Csaw
r—Omtlsew 1M�er ��
_- s Provide 11
learanc�
oat To
Concr
Joist softer W !else slsdls6
pan rafter to BIWASMs
Ahs, mMTs01. - ii s a.u. ii —
im uwwm wu= Iwse webere it to tut.
®c --
'@adL� 14Ls
PS 2a:o
(feet a tads))
2;/
164 e.c.
=6•
11-2
!�
10-6
64
7-11
6-5
6-3 6-6
H 54
tad
22- D.C.
17-10
17-5 3-0
i]-7 10-0
16• op
16-t
1�1 1-1
U-0 61-6
240 •
13-3
12-6 9-2
!-7 1-1
32• -
'lo-io
141
tad
16•' ex.
21-5
11-10 1�-l0
, 5 A-6
26' • _
17-616-7
. 12-1
1.7-0 9-6
32'
14-5 -
11-0 1"
10-2 1-6
4.46
Q�rw
.
I
1 -strep ar
&ease
aa•s�rrasfw,� rbelts
Plate �� •/�.•'
VIA= I�eals��
ragls fir PD.l
sdte e�rtr► S" 'iPM•+
Ad --- -- s• a.p
.....172 y Jl' la'
411... ..20• Ij. W ly
�• est R ..
V
u• 'bile iy'
Nmfiap Note
a. teed Wakes 4n2 pini 0112 ail. pitch W.%h 301
felt Wwlcup class A -
D- eeod. empaiticr. e---4142 V22 pit9h 13/12 tri:.:
fdub" th 154 felt Wde:3ay!. class A
c. 1-1t, L rolled rW. slepe to dra_..
a: lbct sox 3112 alsl��+ ptch.
TYPICAL P.NTM C u
i