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07127 (PAT)44 P.O. BOX 1504 N o . Building 78-105 CALLE ESTADO Address 78-685. 918 M61041a LA,QUI,NTA, CALIFORNIA 92253 Jilin o to r' Mailing Address . 0. Sas 867 ` City Zip Tel. L Quints 92253 564-2953 Contractor Address State Lic.I City & Classif. Lic. # Designer Address' City(Zip (State Lic. # ICE 1SED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed udder provisions of Chapter 9 (commencing with Section 7000) lot Division 3 of the Business and Professions Code, and my license is in full force and effec _SIGNATURE DATE OWNERMILDER 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, danoish, or repair any structure, prior to its issuance also requires the applicant for such pend to fie a signed statement that hes licensed pursuant to the provisions of the Contractors license Law. Charter 9 (cormrrencf ng with Section 7000) of Division 3 of the Business and Professors 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 ch*pemW of Trot more than five hundred dollars (5500).. ❑ I, 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 hinseff or through his own employees, provided. that' such improvements are not entatded or offered for sale. ff. however, the building or improvement is said within one year of completion, the owner -builder wi0 have the burden of proving that he did not build or krwfove 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 bids or improves thereon, and who contracts for such projects with a contractor(s) l-consedprrsuant to the Contractor's license Law.) ❑ 1 am exempt under Sec_ R & 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- . ❑ Certified copy is hereby fumished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed ff the pemrT is for one hundred dollars ($100) valuation or less.) I certify that in the performance of tfrp 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. f1, after mabig this Certificate of Exemption you should become subject to the Workers' Canpasafim provisions of the Labor Code, you must forthwith comply with such provisions or this pemd shat/ be deemed revoked. . . CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec- 3097, CLW Code.) , Lender's Name Lenders Address This is a building permit when properly filled out signed and validated,'anri is subject to expiration if work thereunder is suspended far 180 days: I certify that I have read this application and state that the above information is correct. I agree to comply With all city and county ordinances arid state laws relating to building construction, and hereby authorize representatives .ofthis city to enter the above- mentioned property for inspection purposes. .Signature of applicant Date Mailing Address City,. State, Zip BUILDING: TYPE CONST. OCC: GRP. A.P. Number Parc Asa i uInta ©7127 Legal Description Project Description Patio Cover & Spa Sq. Ft. No. No. Dw. Size Stories i Units New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑ REMARKS _ y 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 Line FINAL DATE INSPECTOR Issued by: Date 2,2/90 Permit Validated by: Validation:_ Estimated Valuation $2,900 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. S, Mech. Electrical Plumbing S.M.I. .14 Grading Driveway Enc. Infrastructure ell /4 7 ti TOTAL c `" REMARKS _ y 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 Line FINAL DATE INSPECTOR Issued by: Date 2,2/90 Permit Validated by: Validation:_ CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ UNITS SLAB GRADE 2ND FL. SQ. FT. BONDING YARD SPKLR SYSTEM STORAGE TANK MOBILEHOME SVC. BAR SINK FOR. SQ, FT. ® DUCT WORK ROCK STORAGE GAR. SO. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APPJEQUIP. DRAINAGE PIPING CARP. SO. FT. TEMP. POLE WALL SQ. FT. Q GROUT DRINKING FOUNTAIN. SQ FT ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES FINAL INSP./ WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTOXDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM VENTILATION 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 GAR. FIREWALL SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® V4c 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 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 FOUND. REINF. 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$-=S LUMBER GR. FINAL INSP./ FRAMING / rf 6 FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL7d 1