002873 (3&4)all
..*hf44Q 44
P.O. BOX 1504 No. 002873
Building OC
Address 55�
-203 ftLA QUINTACAL CALIFORNIAFORN92253
Owner
5u7Cie ommmlY
Mailing
Address �.3
City V01M De4Ieft JZip u Tel.
92260 568-2828
Contractor
.;Mcp- and Lind -
Address
State Lic. I City
& Classif. 288130 Lic. # 328
-Arch., Engr.,
Designer
Address Tel.
City Zip State
• . • Lic. #
LICENSED CONTRACTOR'S DECLARATION
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. ; �: i a? �, s+� .rl-•.r-,-Li'-•!'
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 10 its Issuance also
requires the applicant for such permit to file 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 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 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 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
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
. Strutt 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 to the Contractor's License Law.)
❑ 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
❑ 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 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:
BUILDING: TYPE CONST: OCC. GRP.
A.P. Number
Legal Description
Project Description M � � U 13
F '14 'iia Q
Sq. Ft. Bird: 592 No.
Size - Stogy
Alter ❑
New Add ❑
No. Dw.
Units
Repair ❑ . Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep:.
BY:
Plan Chk. Bal.
ULU
Const.
" S88,.50
.Mech.
S5„00
Electrical
12.17
Plumbing
128.50
S.M.I. -
11.10
Grading
Driveway Enc.
work for which this permit is issued. (Sec. 3097, Civil Code.)
Infrastructure
2,000,00
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
This is a building permit when properly filled out, signed and.validated, and is subject to
TOTAL
3.362..91
REMARKS
1-2 7
certify that I have read this application and state that the above information_ is correct.
Issued by:
Date Owner
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions of the -Labor Code, you must forthwith
comply with such provisions or this permit shall big deemed revoked.
Minimum Setback
Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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.)
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
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
1-2 7
certify that I have read this application and state that the above information_ is correct.
Issued by:
Date Permit
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. r
Validated by:
Signature of applicant r� i f- - f �" r' �-� Date � -
Mailing Address r ✓
Validation:
City, State, Zip
A7199
1 30 3362.91 R
n ; HARD COPY
T
•
CONSTRUCTION ESTIMATE A91 Ilk
NO. ELECTRICAL FE
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
low
UNITS
A.C. UNIT
COLL. AREA
C SLAB GRADE 3 -
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
�OUGH WIRING
c
4,2 D
GAR. SO. FT. Q
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SO. FT. ®
HEATING (FINAL)
WALL SQ. FT. ®
/GREINF. STEEL_7— V- 4
DRINKING FOUNTAIN
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION is
WATER PIPING
NOTE: Not to be used as property tax valuation
SERVICE
FLOOR DRAIN
MECHANICAL FEES
it
V
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
/� FRAMING�/�
((tl�OO/)CJ
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
SPARK ARRESTOR
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
Y SETBACK
ROUND PLU I
UNDERGROUND
A.C. UNIT
COLL. AREA
C SLAB GRADE 3 -
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR SEF5rC KC
O
�OUGH WIRING
c
4,2 D
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
/GREINF. STEEL_7— V- 4
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
41eiNALINSP.
it
V
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
=$
LUMBER GR.
INAL INSP. _Zoi
/� FRAMING�/�
((tl�OO/)CJ
eFINAL INSP. U �1
0(
��`� -(��t!G
PA_
Ili l�
c/ /
� 1
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
KLATHING -2�- Q�- 1
MESH
//y-- INSULATIONISOUND!f ,_ -
FINISH GRADING
O L.FINAL INSPECTION IG)
/ ✓
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS,
GARDEN WALL FINAL 71