08868, 9673 (SFD)J
Building
Address 53"'585
Owner
Suncrown
TAtyl4
•�
P.O. BOX 1504 No. 0886$
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
/_3 7_�
Mailing
Address Box 604
City Zip Tel.
LaQuiuta 92253 564--0733
Contractor
Owner/Builder
Address
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9'(commencing with Section
7000)0f Division 3 of the Business/and Professions Code, and my license is in full force and
effect. /J. ,•r. %� l �f'd,��:r+,�,
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions 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 rile a signed statement that he is licensed pursuant to
the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
.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
subjects the applicant to a civil penafty of not more than rive hundred dollars ($500).
• - ❑ 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
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, the owner -builder will have the burden
i of proving that he did not build or improve for the purpose of sale.) .
i O 1, 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 or property who builds or improves thereon; and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
i ❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner "
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
I- •• , ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date � Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant -Date-
Mailing
ateMailing Address
City, State, Zip
BUILDING: TYPE CONST. OCC: GRP.
�A.P. Number —77A-1 9,q—iI'I
Legal Description
Project Description C*Vn
Sq. Ft.
Size 1466.
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
��rm3.� t�t�>tit�
Y1t's�^ �-'r�t*ITtd�
b'l>ni�k wall � far
annX.
Estimated Valuation
,
PERMIT
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
174.73
Const.
576.50
Mech.
1.09.89
Electrical
159 . S'0
Plumbing
6.02 ,
S.M.I.
20.00
Grading
28_00
Driveway Enc.
2852.05
Infrastructure
a a
TOTAL
3324.69
t?7 6
REMARKS
.... 1,
ZONE: BY:
Minimum Setback Distances:
Front,Setbwk f.rom,Center,-Li,ne
�.�K'Ka"1t"�i yf "$!i �*i`tr1k,,it;fXfit
Rear Se4acv from Rear Pro j . Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
NSPECTOR
Issued by: Date Permit
Validated by: r
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING "PEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE/0
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
FORMS
S ER,
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP.POLE / O
DRAINAGE PIPING
CAR P. I SO. FT.
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN
SO FT ®
SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
_ $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP. Ll
/
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
VENTILATION
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING tV,41 a 9�
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/.c
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 / �0 /)
7
GROUND PLUMBING/
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE/0
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
S ER,
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP.POLE / O
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM :3-5--eWATER
SYSTEM
GRADING
cu. yd.
$ plus x$
_ $
LUMBER GR.
FINAL INSP. Ll
/
FRAMING 1 as 9 .
FINAL INSP.
/M�
ROOFING /' 7
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING tV,41 a 9�
MESH
INSULATIONISOUND 9�/
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
P.O. BOX 1504 APPLICATION ONLY
Building 78-105 CALLE ESTADO
Address LA OUINTA, CALIFORNIA 92253
Owner �st'i/��y �L 1�1r✓.
r , ,..[Jit/
Mailing BUILDING: TYPE CONST. OCC. GRP.
Address 20 -1 ,C/-1 PC///V,-/,I. y
�• A_._P. Number
ity, Zip
CTel.
4 44�",_-PL4 �, �"�// ? Legal Description mT 0 1*11 S . rl/,y(%• L 3
Contractor ' Project Description
City zip
</ �/s//N'7,0 `7Z'Z S ��
State Lic.
4 Classif. ,
Arch., Engr-,
Designer
Address
i' y
City (Zip j a/ (State
Lic. #
LICENSED CONTRACTOR'S DECLARATION) (rj t � 1/
I heretry at inn that,0un licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of, th5)Business and-Prdf ssions Code, and my license is in full force and
effect�1. f �( AYA/�'—� �i r Z ✓7 ` c
SIGNATURE A - ✓ DATE
r r
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec- 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, smprove, demolish,or repair any structure, prior to its issuance also
requires the applicant for such permil_to'tile a signed statement that he is licensed pursuant to
the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7,000) of
Division 3 or the Business and Professions Code, or that. he is exempt therefrom, Cah"e basis
for the alleged exemption. Any violation of Section 7031.5 by •any appfidant for a permit
subjects the applicant to a civil penalty of not more than five hundred'dollars ($500
❑ 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
Professions Code: The Contractor's License.diivi 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. ff. lhowevei, l`"the building
—or improvement is sold within one year of completion, the owner -builder: tWtthaYecihe00rden
of proving that he did not build or improve for the purpose of sate.)lJ.i
❑•I, as owner of the property, am exclusively contracting with licensed contractoWtoicon,
struct the project (Sec- 7044, Business and Professions Code: The Contractor's LlceZ Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt ynder Sec B- & P.C. for this reason
� r f
Dafe/Owner
Y , WORKERS' COMPENSATION DECLARATION
1 hereby affirmAiiat 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 y� Company
Cl Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(this section need not be corePleted if the permit is for one hundred dollars ($100) valuation
or less-)
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ any ppeerson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE. TO APPLICANT: ff, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must .forthwith
comply with such provisions or this permit shall be deemed revoked- If
r
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 Nam-
Lender's
amLender's Address
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 certity that I have read this 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 ,of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date -
Mailing Address
City, State, Zip
BUILDING' DIVISION
r ^ R
Sq. Ft. No. No. Dw.
Size/f�/ epi Stories / Units
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
if
Estimated Valuation
t PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. p
Const.
Mech.
Electrical ;.
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL ,S"- U
REMARKS
09518t.i04,__ _ it
X an I I 2
'IHL_ Y i5. e
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. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT.
GROUT
WATER HEATER
WALL- - -- SQ. FT. ®
FINAL INSP.
- DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SQ. FT. ®
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE:. Not to be used as property.tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIREPLACE
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.
SQ. FT. @ c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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 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
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
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 1/7/91 1 Type of Permit I La Quinta
No. I 103<58 Permit f
Owner NameLog #
Suncrown Corp
No. 53-585 street Eisenhower Drive
City La Quinta . Zip 92253 Study Area 111
APN ii I Tract N Lot # Square Footage 114W
Type of Development Single Family Residence I No. of units
Comments
At the present time, the Desert Sands Unified School District does not collect fees on
garages/carports, covered patios/walkways, residential additions under 500 square feet,
detached accessory structures or replacement mobilehomes. It has been determined
the above-named owner is exempt from paying school fees at this time due to the
following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 1.58 X 11.466 1 or $ 2,31628 have been paid to D.S.0 S.D. for
the property fisted above and that building permits and/or Certificates of Oe ramie, ' 10or
this square footage in this proposed project may now be issued.
Fees Paid By Sun Crown Corp Telephone
Name on the check
By Richard M. Beck
Director, Facilities Planning & Development
Fee collected /exempted by Marcia Ewart
Signature V
Payment Reeeived
Check No. 1374
Collector: Attach a copy of County or City plan check application form to District copy.
Embossed Original- Building DeptJApplicant Copy - Applicant/Receipt Copy - Accounting
RECORDING REQUESTED BY ,
COMMONWEALTH LAND TITLE CO.
AND WHEN RECORDED MAIL THIS DEED AND,
UNLESS OTHERWISE SHOWN BELOW, MAIL TAX
STATEMENTS TO:
le F
C4 SUN CROWN CORP.
U: POST OFFICE BOX 804
LA QUINTA, CALIFORNIA 92253
ESCROW NO.
TITLE ORDER NO
6-11449—LB
163606
0
cc
O
—'W be
t= W vCCC=)
..V 5V $
y
IL a > {{, tad r�
C
•, yri
SPACE ABOVE THIS LINE FOR RECORDER'S USE
GRANT DEED
The undersigned grantor(s) dee(s):
Documentary transfer tax is 28.60 A.P.N.
( X ) computed on full Va ue of property conveyed, or
( ) computed on full value'Tess value of liens and encumbrances remaining at time of sale.
( ) Unincorporated area: ( X ) City of LA QUINTA , and
By this instrument dated
FRANK ZARAGOZA,
A SINGLE MAN
hereby GRANTS to
TWENTY—FIRST DAY OF SEPTEMBER, 1990 , for a valuable consideration
SUN CROWN CORP.
A CALIFORNIA CORPORATION
the following described real property in the CITY OF LA QUINTA
County of RIVERSIDE , State of CALIFORNIA
LOT 4 OF BLOCK 245 OF SANTA CARMELITA AT VALE LA QUINTA 423 AS PER MAPS
RECORDED IN BOOK 20, PAGE 25 OF MAPS IN THE OFFICE OF THE COUNTY RECORDER OF
SAID COUNTY.
STATE OF CALIFORNIA,
COUNTY OF RIVERSIDE
On October 22, 1990 before me
SS
the undersigned, a Notary Public in and for said County and State,
personally appeared
FRANK ZARAGOZA
proved to me on the basis of satisfactory evidence to be the person(s)
whose name(s) is/arc subscribed to the within instrument, and
acknowledged to me that he/she they executed the same.
WITNESS my�y hand and official @al.
CL� c
-- FRANK ZARAGOZA
MAIL TA'X STATEMENTS TO PARTY SHOWN ON FOLLOWING LINE; II" NO PARTY IS SHOWN, MAIL AS DIRECTED ABOVE.
APD730 Name Street Address City & State
�
=', r
OrPICIAL SEAL
TONT S. ROMANO
t'
NOTARY PUBLIC - CALIFORNIA
RIVERSIDE COUNTY
My comm. expires hlAY 6, 1994
MAIL TA'X STATEMENTS TO PARTY SHOWN ON FOLLOWING LINE; II" NO PARTY IS SHOWN, MAIL AS DIRECTED ABOVE.
APD730 Name Street Address City & State
s�
.es
V
JAMES O. WALLACE
Agdculfural Commissloner
(Xhector of Welghls a Measures
OFFICE OF
AGRICULTURAL COMMISSIONER
AND.
WEIGHTS & MEASURES CALVIN C. KAMINSKAS
4080 LEMON STREET, ROOM 19 Asslslanl Commisslonor
RIVERSIDE, CALIFORNIA 92501 CLEMENT BENVENISTE
(714) 787-2561 Sealer
49613 Highway 86, Suite B12
Coachella, Ca. 92236
DATE i l /��90 (619) 3421
CASE NO.
DEVELOPER'S NAME: 5"A_ Ce -d ww Coe;. -
O. -
ADDRESS: !.� 0, adX �--o
La�;.1-� 'I Z -Z 5
TELEPHONE)S�
Dear Developer:
After reviewing your landscaping plans, all plant material listed is not in
violation of quarantine laws governing the Coachella Valley. If substitutions
do. occur and they differ from plant material listed, this office must be notified
immdiately.
Thank you for protecting and preserving the Coachella Valley's pest -free environment.
cz"
l
Agricultural Cannissi er's Office.
cc: Indio and Riverside Office
4.4
P.O. BOX 1W4 No. 9673
Building 78-105 CALLE ESTADO
Address 53-585 EISENHOWEi LA QUINTA, CALIFORNIA 92253
Owner -I
SUHCROWN CORP.
Mailing
Address .' BOX 804
City Zip Tel.
LA QUINTA,CA 192253 1 564-0793
Contractor
W. R. ROGERS-GENERAL CONTRACTORS
Address
67720 PERENTA
City ip Tel.:
CATHEDRAL CTTV 92234 32208083
State Lic. City
& Classif. 291728 Lic. # 1954
Arch., Engr.,
Designer
Address Tel.
City izip State
Lic. #
LICENSED CONTRACTOR's DECLARATION
I hereby affirm, that I A) lic�ns(�J under provisions of Chapter 9 (commencing with Section
70 fOO) of Division 3 -of the B - usi'negs add Professions Code, and my license isin ull force and
act -9
at
fA
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from tAe�eontractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions 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 rile a signed statement that be -is licensed pursuant to
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
subjects the applicant to a civilpenalty ofnot more than rive hundred dollars ($500).
0 1, as owner of the property, or my employees with wages as their sole compensation, will
do the. work, an d 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 safe. If, however, the building
of improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of safe.)
0 1, 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 —_
does not apply to an owner.of property whobuilds; or Improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec.—B. & P.C. for this reason
Date -------;—Owner
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 certifietcopltie,,Leof.L(SWftpO, Labor Code.)
Policy.No.—Company : JL I —
0�opy Is filed with the city. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
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 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.
Date—Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you. should become
subject to 'the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a constr ' uction lending agency for.the performance of the
work for which this permit is issued: (Sec. 309 7, Civil Code.)
Lender's Name
,Lender's Addre
This is a buildin� permit when properly filled out, signed and validated, and is subject to
expiration it work I ereunder 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 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.
Signature of applicant Date,
Maili ' ng Address
City, State, Zip
BUILDING: TYPE CONST. &FD OCC'. GRP.
A.P. Number
,Legal Description
Project Description THIS IS A SUPPLEMENTAL
PERMIT FOR 8868, TO SHOW CHANGE OF
—OWNER/B'w"ILDER TO CONTRACTOR.
SO COHARGE
Sq. Ft. No. No. Dw.
Size Stories Units
New 0 Add 0 Alter 0 Repair 0 -Demolition 0
5timated. Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Eric.
Infrastructure
No charge
TOTAL
0
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
-Side Street Setback frorri Center Line
-Side Setback from Property Line
FINAL DATE -INSPECTOR
Issued by: Date_Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING tEES
1ST FL. 50. FT. g $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. $0. FT. g
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
MOBILEHOMESVC.
BAR SINK
POR. SO. FT. @
GAS(ROUGH)
METER LOOP
GAR. $0. FT. 0
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. 0. Fr. @
GROUT
WATER HEATER
WALL $0. FT. 0
FINAL INSP.
DRINKING FOUNTAIN.
SQ. FT. @
WATER SYSTEM
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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYST�M FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. BJ.U.
SO. FT. (& c
BATH TUB
LATHING
SO. Fr. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID g 1% c
SEWAGE DISPOSAL
SO.FT.GAR @ V4c I
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBIL
I . TOTAL FEES
MICRO FEE
MECH.FE=JEPL.CK.FEE
I 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
ROCKSTORAGE
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTORS SIGNATURES/INITIALS
GARDEN WALL FINAL