10873 (PAT)P.O. BOX 1504 No. 10873
Building8-'S38��'�kCaala LA Q 78-105 CALLE ESTADO V Address UINTA, CALIFORNIA 92253
Owner
Donald Guarase ea
Mailing BUILDING: TYPE -CONST. OCC: GRP.
Address Sams'•
A.P. Number
city. La i�t1.3.nta g 2253 Legal Description
Contractor Project Description
ow er/Builder
. Pa'fr3.G' CC3vE•,X'
Address
City Zip Tel.:
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
'
Size 534 Stories -Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition.❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter (commencing with Section
7000) t. of Division 3 of the Business and Professions Code,and my license is in full.force and
effec.
SIGNATURE' DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirin that I am exempt from the Contractor's License Law for the following & g
reason: (Sec. 7031.5,Busfmnss and Professions Code: Any city or county which requires a
43-00
permit to construct, after, improve, demofsh, or repair any structure, prior toils issuance also.. -
requires the applicant for such permit to fife 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 -
Dbvision 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 penally of not more than five hundred dollars.($500).
61, as owner of the property, or my employees.with wages as their sole compensation, will Plan Chk. Bal. 58.50
do the work, and the structure is not intended or offered for sale..(Sec. 7044, Buisness and CpnSt.90.00
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, Mech. -
provided that such improvements are not intended or offered for sale.'If,: however, the building
or improvement is sold within one year of campfetion, the owner -builder .will have the burden Electrical
of proving that he did not build or irmrove, for the purpose of sale.) "
❑ I, as owner of the property; am exclusively contracting with licensed contractors to con- Plumbing '
struet the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property: who,bmtds or improves thereon, and who contracts for S.M.I. - - - 7
• such projects with a contractor(s) licensed isuamt to the Contractorls License Law.)
❑ 1 am exempt under Sec- / • w- & P.C. for this rea on Grading
�f f / Jif/ 1 Driveway Enc.
Date Owner `1•''�7%Pf�%Z'e```� t `�'`t Infrastructure
WORKERS' COMPENSATION DECLARATION '
I hereby affirm that I have a certificate of consent to self -insure, or a certificate -of
Wo rker's.Compensation Insurance, ora certified copy thereof, (Sec. 3800; Labor Code.)
Policy No. .Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL g.;o n;tr
CERTIFICATE OF EXEMPTION FROM REMARKS.
WORKERS' COMPENSATION INSURANCE-
(This
NSURANCE-
(Thi sssectron need not be completed f the permit is for one'hundred dollars ($100) valuationor -
I certify. that in the a�
ty performance of the work for which -this permit is issued, I shall not '
employ any person -in any manner so as to becomeisutije6t to the Workers' Compensation
Laws of California f v
' Date rlwne';` Y, t-?° 1
NOTICE TO APPLICANT:, H,IaRar maki g• 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 orthis Permit shall bedeemed revoked. Minimum_'SetbackDistances: - -
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, Ciw7 code.) Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 100 days. ' ' '
I certity 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 Validated by:
Signature of applicant Date
Mailing Address - Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
i
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1SY FL. SQ. FT. ® $
2ND Fl,--' SQ. FT. ®
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SO. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT . WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMWERM
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 ® 1+/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
REMARKS:
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 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
ef/FOUND. REINF. 5=�2 -�2
J
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.
O(FRAMING6-15--792-
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING0
Ax /
AU—FINAL INSPECTION
l
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL