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07611 (SFD)44a P.O. BOX 1504 N o . BuildinAddrress 48.556 Via Elacanto LA Q78 105 CALLE UINTA, CALIFORNIAORNIAESTAD92253 Owner Abe, & Thelma Grosswn Mailing Address 9010 Corbin Avenues Suite S-3 City Zip Tel. . Rofthildge 91324 818-349-5894 Contractor Regal RMS, Inc. Address 3184 Airway Avenue City Zip Tela Costa Mesa 92U6 346-5430 State Lic. City & Classif. 446587 Lic. # 1566 Arch., Engr., Designer Address Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70 OO) 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, 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 the provisions or 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 rive 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 isnot 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- 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 projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason DateF 1 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 0 Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (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 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. Date Owner NOTICE TO APPLICANT. If, after making this. Certificate or Exemption you should become subject to the Workers' Compensation provisions or the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby 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 certify that 1 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.. mentionedproperty for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip BUILDING: TYPE CONST. OCC: GRP 07611 A.P. Number Legal Description Project Description Tract 2W52-5 Plan SS Lala Do La Pala Lot 3.1 Sq. Ft. 2()01 Size No. No. Dw. -. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ t Estimated Valuation $103,145 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 548..1U Const. 653.50 Mech. 66.50 Electrical 112.36 Plumbing 144.50 S.M.I. 7.28 Grading Driveway Enc. Infrastructure - 2420,76 TOTAL P C1 REMARKS 9._... RI; i21: %ii 3b�X2�A s p'- . u*I�.1'% Yd3Ktax. �. asrs:r tiCA'id%r ZONE: BY: Minimum Setback Distances: Front Setback from Center Li rte Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATEINSPECTORR Issued by: Date 4'19"/"Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SQ. FT. POR. SO. FT. ® GAR. SQ. FT. ® CAR P. SQ. FT. WALL SQ. 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 ROUGH PLUMB. FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED AS (ROUGH) SO-'L�)- LAUNDRYTRAY AIR HANDLING UNIT CFM HEATING (FINAL) 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. SQ. FT. ®c BATH TUB BOND BEAM SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL LUMBER GR. SQ.FT.GAR ® V4c HOUSE SEWER rf FRAMING teROOFING FINAL INSP. 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 SETBACK WOUND PLUMBIN UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS WER OR ROUGH WIRING DUCT WORK ROCKSTORAGE OUND. REINF. '2— Gj GG AS (ROUGH) SO-'L�)- 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. /�� NAL INSPZ — .0 � �v rf FRAMING teROOFING FINAL INSP. PA5REMARKS: Ole 76 A 4! VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH I SULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL