11784 (RR)Building
Owner
c&4 . 4
u
P.O. BOX 1504
51-080 Eisenhower LA QUINTACCAL FORNIA 92253
Jim Vedral
ng
nuc 51-080 Eisenhower
Citta Quinta, Cflp 92253 ITeI' 1
CO tractor
sort Valley Construction
Address
445 S. State
San Jacinto, ICA 92383 1(714)654-1980
ko
State Lic. I City
& Classif. 447139• e_3� Lic. #
Arch., Engr.,
Designer
Address
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I her by Jffinn that"I am llcen ed under Orovl ons of Chapter 9 (commencing with Section
7000) jf LJlvision 3 of the Busies and Profesaons Code, and my license is in full force and
OWNER•BUILDER DECLARATION
I hereby affirm that tam exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness and Professions
Code: 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 Ole 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 andProfessionsCode. or that. he is exempt therefrom, and the basis
/or the alleged exemption. Any violation o/ Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty o/ not more live hundred dollars ($500).
O, 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
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,
provided that such Improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, Me owner -builder will have the . burden
o/ proving that he did not. build or Improve /or the purpose of sale.)
O 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 contractor(s) licensed pursuant ro the Contractor's License Law.)
❑ 1 am exempt under Sec. B. i3 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby afflrm that I have a certificate of consent to self -Insure, or a certificate of
Worker's Compensation Insurance, or a certif)e c pyYther000f.+( . 3800, Labor Code.)
Poli�� Company �YJjJ� 11 /�
I -Copy is filed with the city. ❑ Certified copy is he furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION IN
(This section need not be completed i/ the permit !s /or one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thF 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.
Date owner
NOTICE TO APPLICANT: It, after making this
Certificate of Exemption you should become
subject to the Workers' Compensation provisions o/ the Labor Code, you must forthwith
comply with. such provisions or this permit shall be deemed reroked.
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 It 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 countyordlnancea and state laws relating to building
construction, 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
No. 11784
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Project Description Reroof
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑
Demolition ❑.
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. 'Bal
Const.
30.00
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
30.00
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: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SO. FT.,®
HEATING (ROUGH)
STORAGE TANK
POR. SQ. FT.
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
DRAINAGE PIPING
CAR P. I SO. FT. ®
HEATING (FINAL)
OTHER APPJEQUIP.
WALL SO. FT. ®
DRINKING FOUNTAIN.
SQ FT 0
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
/
1
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
FIREPLACE
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
HOUSE SEWER
LATHING
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 APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
Cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
/
1
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