06303 (SFD)P.O. BOX 1504 N o . 06301
Building 78-105 CALLE ESTADO
Address 48-229 Calle Flosi8tas LA QUINTA, CALIFORNIA 92253
Owner
Mailing "` I.XA.M.&M.:3 " vnrara U1 BUILDING: TYPE CONST. OCC: GRP.
Address 9010 Corbin Ave„ S--3A.P. Number
617-652--015
City Zip Tel.
Northridge 91324 Legal Description
Contractor jar it f-, /s , A 0, r Project Description Tract 20052-2 • Plan IR. Lot 15
Address ?j 1,y fj? r �� f. ,�'+•.� ij1=
City, c Zipfe-zt, z !r Tel.
-PAIM-Des"IT 1-42-2-W 44 -5 -500 -
State Lia V414- 4 �;7 City / i;t. &
& Classif. —4-$ 4.1-91,,,,....x, Lic. # -260— Sq. Ft. 1552 No. No. Dw.
Arch., Engr., Size Stories Units w
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 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
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, after, 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 provstons 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
fort the alleged exemption. Any violation of Section 7031.5 by -any applicant for a permit
subjects`the applicant to a ch* penalty of not more than rive hundred dollars ($500).
❑ 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 said 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 sale.)
❑ 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 of property who builds or improves thereon, and who contracts for
such protects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
f
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
I worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
❑ Copy is filed with the city. O. 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 tht 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
m Date Owner
N077CE 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.
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 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
IEstimated Valuation $96,142
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
AMOUNT
REMARKS
; 't .ii;irn3e4 9�,'#4n jam{ 2 7-V'LlA. r� 1x4
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
9119/89
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT, ® $
UNITS
SLAB GRADE - L/✓
t
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT,
FORMS
ER OR sa
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
1 AS (ROUGH) —Of G�d
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. Sp, FT_ ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. I SO. FT, ®
FINAL INSP.
WALL SO. FT,
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu. yd.
$ plus x$
_$
URINAL
SO FT ®
FRAMING Ol
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
To
A
WATER PIPING
NOTE: Not to be used as property tax valuation
REMARKS
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
SPARK ARRESTOR
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
INSULATIONISOUND /
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK ` „
GROUND PLUMBI
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE - L/✓
t
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER OR sa
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
1 AS (ROUGH) —Of G�d
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
(.ZS (FINAL) `G(v
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
NAL INSP..2 .70
FRAMING Ol
FINAL INSP.
WOOFING /% _�G�
To
A
l2 0.6
REMARKS
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING G
MESH
INSULATIONISOUND /
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL