05249 (SFD)Tjbt 4 4 Q"
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 48-113 Via He rmo Bs LA OUINTA, CALIFORNIA 92253
Owner '
Mailing
Address 9010 Cobbiso Ave., Suite :3
City Zip Tel.
Northridge, 91324 1886-349-.3.894.
Janes Cashman/Sterling Com.
Address
77' -20th Minueaota
City , Zip Tel_
& Classif. 19 53 33 I Lic_ #
Designer
Address'
City( Zip I
State
Lia #
LICENSED CONTRACTOR'S DECLARATION .
1 herebpaffirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and. Professions Code, my license is in full force.and ,
effect. a� ,e4•-
.,� ,;.rta...!.,.+,v •::+d` � ,/'mss .'..- .�''�.,•�wsi+:..r�� �i' ��.1•"
._SIGN ,y /r. DATE
titi F OWNEWBUILOER DECLARATION t
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Busmess and Professions Code: Any city or eoudy wfieh requaes a
permit to construct. after. improve. demolish. or repair any strum". prior to its issuance afro
requires the applicant for such permit to file a signed statement that hes licensed pursuant to
the provisions of the contractor's License Law, Chapter 9 (co meerrcig with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therdmm, and the basis
for the affeged exemption. Any violation of Section 7031.5 by arty appkad for a pemnit
subjects the applicant to a civil penalty of not more than five hundred dafars (5500).
O I, as owner of the property, or my employees with wages as their sole compersatkuk will
do the work, and the structure is not intended or offered for sate. (Sec 7044, Bwisress and
Professions Code: The Contractor's License Law does not appy to an owner of property who
builds or urproves thereon and who does such work himself or Ihrough his own anmbyees,
provided that such improvements are not intended or offered for sada. 9, however, the building
or improvement is sold within one year will completion, the owner-buWar whave the burden
,or
proving that he did not build or fmprove for the purpose of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to coo-
struct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not appy to an owner of property who bu bds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractors 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
. O Copy is filed with the city. O Certified copy is hereby tumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the pemnit is for one hundred dafws (S100) Wakeham
or less.)
I certify that in the performance of the work for which this permit is issued, 1 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 O, after makirng this Cedificate of Exemption you shmdd become
subject to the Workers' Compensation Provisions of the Labor Code, you mist forthwith
comply with such provisions or this permit shalt be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the peruman efof the
work for which this permit is issued. (Sec. 3097, CIO Code.)
Lender's Name
Lenders 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 cerlity 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 orf this city to enter the above,
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip _
No. 05249
BUILDING:. TYPE CONST. OCC: GRP.
A.P. Number 617-940-015
Legal Description
Project Description ^ PIau U9 Lot 15
Sq. Ft.No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
9 3 ( . R 3
Const.
4100.50
Mech.
19
Electrical
A? A&
Plumbing
9 P. 00
S.M.I.
Grading
Driveway Enc.
Infrastructure.11�
TOTAL
4' . alis ei .'s'i r 1 /• , , jt'ti
REMARKS
S i! (Rf7f7!'t �F 31C i Tilt. .T .�"t(d:l i Kii
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 Lane
FINAL DATE INSPECTOR
Issued by: Date
12/30/88 'Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. @
GAS (ROUGH) 0
METER LOOP
GAR. SQ. FT. ®
I IPOWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT.
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN.
BOND BEAM
WATER SYSTEM
URINAL
SO FT ®
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
�7
FRAMING (yJ
v
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
REMARKS:
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
MESH
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
FINISH GRADING
SO.FT.GAR ® 3/ic
HOUSE SEWER
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 /J PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
OUND PLUMBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) 0
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. ` /4
�7
FRAMING (yJ
v
FINAL INSP.
ROOFING v/ WIT
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING jl (u/ G
MESH
INSULATIONISOUND !�
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL