04859 (RR)Bu
P.O. BOX 1504
47-600 Wisanh4Awar LA QUI,NTACCALIFORNIA 92253
Owner
Mailing
Address
cltyla Quinta Z1p92253
Contractor
Obtlern Roof
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number d=onta ro Estates
Tel.
Legal Description
_ Project Description_ Rra--rnor
%co 1. B02C 935
ty Zip Tel.
29 Palm 1 1 362-
& Classif. I Lic. #
Designer
Address
CityI Zip ( State
Lic. #
LICENSED CONTRACTOR'S. DECLARATION
I hereby affirm that I am licensed underprovlelone of Chapter 9 (commencing with Section
7000) of Olvis)on 3 of the Business and Professions Code, and my license Is In full force and
effect. -
SIGNATLfiE DATE
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Proresalons Code: Any city or county which requkea a
permit to construct, alter, Improve, demolish, or.repelr any structure, prior to ice Isauence also
requires the' appllcarmt for such permit to file a signed statement that he Is licensed pursued to
rhe provisions of the Contractor's License Law, Chapter 8 (commencing with Section 7000) of
Division 3 of the Business and Piolesslons Code, or that. he Is exempt thershom, and the beak
for the =god exemption. Any violation of Section 7031.5 by -any epp6cant for a permit
subjects =god
to a choir penalty of not more than tive.hundred dollars (sao0).
'❑ 1, as ownerof:the property, or my employees with wages as their sole compensation, will
do tlia,wOrk, and4he<atgoe is not Intended.or offered for eale.;(Sec. 7011, Bubneas and
do fh tans Coda:: The' Ctor's License Law dose naf appy to err owner pf property w7mo
.bulkls'or-yripoves:�thered who does such work hlinself w thpio'.tier".such:Improts ere not intended w ofrered for eels. M, however, the bWM6p
or
impnoyerirenr;;ls ;sold wkhkn one year of compietbn, the owner builder will Aeve the burden
of proving that'lie dkl_noYWW 0, dmprovs k the purpose of. sale
❑ I, as-_"nei.of.the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7011, Business and Professions Code: The Coimgctor.'s License Law
does not apply to an owner of property who bulls or improves thereon, and who cortiicts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under .Sec. -B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
[hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurence, ora certified,c`opy4hereof. (Sec. 3900, Labor Code.)
Policy No. Company �y '" f
❑ Copy Is flied with the city. ❑ Certified copy Is hereby furnished.
CERTIFICATE OF EXEMPTION iFROM
WORKERS' COMPENSATION INSURANCE
(Thiseas:) section need not be completed it the permit Is for one hundred dollars (1100) valwrbn
or l
I certify that In the performance of tho work for which this permit is Issued, I shall not
employ any person in any manner sous to become subject to the Workers'. Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: ti, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of. the Labor Cods, you must fwthweh
oompy with such, provisionsor this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that; there is a construction lending agency for the performance of the:
work,
ork for which this permit is Issued. (See. 3097, CIO Code:)
Lender's Name
Lenders Address
This Is a building permit.when.properly filled out, signed and validated, and is subject to
explratlon it work thereunder Is suspended,for180 days.
I certify that I' have readthis; 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
construction, and hereby authorize representatives hot this city to enter the above-
mentioned property for Inspection purposes.
Signature of applicant Data.
Mailing Address
City, state, it
Sq. Ft.
No.
Stories
No. D,w.
Units
New O Add ❑ Alter ❑ Repair ❑ Demolition ❑
jj:
WHITE -FINANCE, PINK -APPLICANT,; GREEN- BUILDING,
$4a4Q
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
AMOUNT
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 .DATEI�SQ .13 8
Issued by: Date 77�� jj // Permit•
Validated by:
Validation:
GOLDENROD - A8tiE880R'8 OFFICE, HARD COPY - FILE
0
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT h t
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL. SO FT. Q
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOSILEHOME SVC.
BAR SINK
POR SO FT4t
GAS (ROUGH)
METER LOOP
GAR SO. FT. at
POWER OUTLET
ROOF DRAINS
J
TEMP. POLE
DRAINAGE PIPING
CAR P SO FT 0
GROUT
WATER HEATER
WALL SO. FT. M
FINAL INSP,
DRINKING FOUNTAIN,
SO. FT. M
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION is
=S
WATER PIPING
NOTE Not t0 be used as propeAy lax valuation
FINALJNSP•
FLOOR DRAIN
MECHANICAL FEES
WATER'SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISHI
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
I 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
LATHING
SO. FT. c
WATER HEATER
MAX..HEATER OUTPUT, B.T.U.
SO. FT. RESID.a IYi c
SEWAGE DISPOSAL
SO.FT.GAR a 3Ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL.FEES
MICRO FEE MECH.FEE
PL.CK.FEE
CONST. FEE ELECT. FEE
SMIFEE 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 APP.IE0U1P.
REINF. STEEL
GAS,(FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP,
BOND BEAM
WATER SYSTEM
GRADING
-Cu. yd.
= plus x$
=S
LUMBER GR.
FINALJNSP•
FRAMING
FINAL INSP.
ROOFING
�v � )
�! � � v
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR -
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
,
GARDEN WALL FIN L