002861 (SFD)P.O. BOX 1504 No, 002861
Building55-269 Fireg LA QUINOTACCALIFORNIAALLE DO
ddress 92253
Owner
` im BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address 7s—otos agar xv ciub Drive A.P. Number
CityZip Tel.
., � 9226G 568-282 Legal Description
Contractor Project Description YKA ' FSS 14 B
4� Q PI.c'3F1
Address
City Zip Tel.' .
State Lic. City EM 3142
& Classif. Lic. # Sq. Ft. 589 No. No. Dw.
328 Size Stories Units
Arch., Engr.;
Designer New Q Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
. . . .. . . Lic. #
LICENSED CONTRAC.TOR'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 .✓ n .t4 .,i7.: - �'• "I rfs� i t
-
SIGNATURE '+ DATE _ - -
OWNER -BUILDER DECLARATION Estimated Valuation
.
I hereby affirm that I am exempt from the Contractor's License Law for the following S$� ��
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a 215,834.00
pemi8 to construct, alter, improve, demolish, or repair any structure, prior to its issuance also _
requires the applicant for such permit to file a signed statement that he is licensed 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 alleged exemption. Any violation of Section 7031..5 by 'any applicant for a permit Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
C1'
1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 593.44
do the work, and the structure is not intended or offered for sale.•(Sec. 7044, Buisness and COf1St.
723.00Professions 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.�•
provided that such improvements are not intended or offered for sale. If, however, the building
00
or improvement is sold within one year of completion, the' owner -builder will have 'the burden Electrical
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- Plumbing�(�
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.'
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date Owner Infrastructure 2.000.00
WORKERS' COMPENSATION DECLARATION
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 ..
0 Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE • S
(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 thg work for which this permit is issued; I shall not ^
employ any person in any manner so as t0 become subject to the Workers' Compensation
Laws of California.
Date Ownei '
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 .Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. '
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING.AGENCY Side Street Setback from Center Line
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 certify that I have read this application and state that the above information is correct. Issued,by: Date 1-27—R7 Permit
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.r 'A .r L�� { Date � `r
Mailing Address Validation:
City, State, Zip
A 7 2 0 3 1 30 3655,68 1
HARD COPY
T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL F�
NO. PLUMBING FEES
1ST FL. SQ. FT. ®
UNITS
� "LAB GRADE 3 a
OUGH PLUMB.�i C
ONDING 3 -7
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
FORMS
WER OR SEPTIM;,',
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. I SQ. FT. ®
GROUT
WATER HEATER
WALL SQ. FT. ®
INSP.
DRINKING FOUNTAIN
SQ. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
LUMBER GR.
WATER PIPING
NOTE: Not to be used as property tax valuation
INAL INSP. 2-
FLOOR DRAIN
MECHANICAL FEES
('� / l�j •SCP
A,^
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
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.
SO. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE EPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
!u SETBACK
ROUND PLUMBIt�r�L( Q�
UNDERGROUND
A.C. UNIT
COLL. AREA
� "LAB GRADE 3 a
OUGH PLUMB.�i C
ONDING 3 -7
HEATING (ROUGH)
STORAGE TANK
FORMS
WER OR SEPTIM;,',
ROUGH WIRING
DUCT WORK
ROCK STORAGE
f /FOUND. REINF.3 C
G
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
�REINF. STEEL J
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE eCeNAL
INSP.
BOND BEAM
WATER SYSTEM
&eINAL INSP. `?—� / �t
$
GRADING
cu. yd.
plus x$ -$
LUMBER GR.
elo RAMING �(/j�
INAL INSP. 2-
fA(,I/_ROOFING Cil
,1 G,� O/G TO k/�ic/A�O
/✓ /1Qly ,V�Ce,
/✓
('� / l�j •SCP
A,^
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING S
MESH
/INSULATION/SOUND
FINISH GRADING
YAKIFINAL INSPECTION 7
o -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL