003518 (OFC)G�
1-4
P.O. BOX 1504 N o . € 03 518
Building 7$'-090 Calle Estado LA QUINOTACCALIFORNIA92253
Address -
Owner
Robert Monroe
Mailing
Address P. 0- Anx 329
City Zip Tel.
r --..n fly" 4va+.M a171r%14
Contractor
. Rick Johnson Construction
Address
City Zip Tel.
State Lic..City
& Classif. 397169 Lic. #
Arch., Engr.,
Designer
BUILDING:"TYPE CONST. OCC: GRP. "
A.P. Number 769-101-006-007-008
06--007-008
Legal Description
Project Description rA-Am s o. rnia1, /1-xff3t'trta,
SO. Ft. No.
Sizii e +�508 Stories
Stories 2 Unitss -
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
. LICENSED CONTRACTOR'S DECLARATION
y
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. __11/11 - r i p r.
v
SIGNATURE - �' DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
-$324,735
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repairany structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that heislicensed 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 Any Section 7031.5 'any for
Plan Chk. Dep.
_
$250.00 -
alleged exemption. violation of by applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500):
Plan Chk.- Bal.
C
573.95 7 9 f35
9
O 1, as owner of the property, or my,employees with wages as their sole compensation, will
J J .
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
995.50Professions
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.
1815.00provided
that such improyements 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
Electrical
142.62
of proving that he did not build or improve for the purpose of sale.J
❑ I, as owner of the property, am exclusively contracting with licensed contractors to•con-
Plumbing
1.21.00
• 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
S.M.I. -
22 72
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
D 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
20.00
Date owner Infrastructure
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
... ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
1
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
i (This section need not be completed it 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
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.)
Lenders Name
Lender'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.
1_certify that I have read this application and state that the above information is correct.
1 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
0
66.12
.31 1 -'s1 !�r__t
REMARKS
._"t f3�,t.!ary"r`,'%` f''.r„•. ;,,,:-.c.e 1+'�.,+',s�s,'•3`Ist~V•1 .+ i' T --tj
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: Date12/9187 Permit
Validated by:
Validation:
HARD COPY
Y
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
UNITS
SLAB GRADE La ? f %%L�
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. SQ. FT. @
POWER OUTLET
ROOF DRAINS
(FINAL)
AdEMP. POLE 2,7
DRAINAGE PIPING
CAR P. SQ. FT.
GROUT
WATER HEATER
WALL SQ. FT. @
FINAL INSP.
DRINKING FOUNTAIN
SO. 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
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, TEM/PERM
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
INSULATIONISOUNDy 3
SQ.FT.GAR @ 3/4c
HOUSE SEWER
FINISH GRADING
GAS PIPING
PERMIT FEE
FINAL INSPECTION
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
ROUND PLUMBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE La ? f %%L�
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./EQUIP.
REINF. STEEL �� a f -7-7,GAS
(FINAL)
AdEMP. POLE 2,7
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
.
_$
LUMBER GR.
FINAL INSP.
FRAMING )
O�
FINAL INSP.
ROOFING
c
jjj 111
'
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
•
SPARK ARRESTOR
sG� FIREWALL 3
LATHING
MESH
INSULATIONISOUNDy 3
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL