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07261 (SFD)ce 4 P.O. BOX 1504 Buildin78-105Addrress 78-27€T Via Sevilla LA QUINTACCALIFORNIA 92253 Owner Deane Domes Mailing Address 15 Agusta City lZip Tel. . Rancho 14i r 9e 92270 Contractor Sam Address Tel.: State Lic. I City & Classif. 50008 Lic. # Arch:, Engr., Designer Address Tel. CityI Zip I State Lic. #' LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that 1 am licOnsed:anderprovisions of Chapter 9 (commencing with Section 7(100) of Division 9 of the Business Professions Cade, and my Iicens is i t II forceand effect. `�,4 Fk; -D ��A�� rya ��,. • ' SIGNATURE �•��s+ ��° DATE OWNER -BUILDER DECLARATION I hereby affirm that I am• exempt from the Contractors License Law for the following reason: (Sec. 7031.5,8usiness and Professions Code: Any city or county which requires a permit to construct, atter, Improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to We a signed statement that he is licensedpursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of ,t '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 (S500). ❑ 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 himself or through his own employees, provided that such Improvements are not intended or offered for sale. It, however, the building or improvement is sold within one year of canpletron, the owner -budder will have the burden of proving that he did not build or improve for the purpose of safe.) ❑ 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 bnproves thereon, and who contracts for - such projects with a contractors) licensed pursuant to the Contractor's 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 ❑ Copy is filed with the city. O. Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (This section need not be completed if the permit is for one hundred dollars (S100) 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 of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall 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, 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 certity that I have read this application and state that the above information is correct. I agree'to comply with all city and countyordinances and state. laws relating to building construction, and hereby authorize representatives -of this city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City,. State, Zip No. 07261 ,Y BUILDING: TYPE CONST. OCC: GRP. r A.P. Number 613-402-004, 009, 020 Legal. Description Tent. Tr. No., 23971 Project Description Phase I A Lot 9 Sq. Ft. Mo No. 2 No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation S171,250 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. $482.59 Const. 891.50 Mech. 66.50 Electrical 163.62 Plumbing 150.50 S.M.I. I .04 Grading Driveway Enc. Infrastructure TOTAL REMARKS 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 2/28/90 Issued by: Date Permit Validated by: Validation: _.' CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES -> 1STVL. Sp. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. YARD SPKLR SYSTEM 2ND FL. SO. FT. HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® DUCT WORK ROCK STORAGE FOUND. REINF. — % C POWER OUTLET ROOF DRAINS GAR. SQ. FT. ® HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) DRAINAGE PIPING CAR P. SQ. FT. ® GROUT WATER HEATER DRINKING FOUNTAIN. WALL SQ. FT. FINAL INSP. BOND BEAM WATER SYSTEM URINAL SQ. FT. GRADING cu. yd. $ —Plus—X$—=$ ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. (� WATER PIPING NOTE: Not to be used as property tax valuation ROOFING �( �(Z i L�) C FLOOR DRAIN MECHANICAL FEES REMARKS: WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY 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. SO. FT. ® c BATH TUB MESH INSULATION/SOUND"/ W SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1 Vi c SEWAGE DISPOSAL SQ.FT.GAR ® 3'ic HOUSE SEWER FINAL INSPECTION 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 SETBACKS ROUND PLUMBIa- UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR S ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. — % C GAS (ROUGH) QQ 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. (� FRAMING R "W �,o FINAL INSP. /l � qo o ROOFING �( �(Z i L�) C / �,,,� �/ 11 /� S — �[/YC� to OCJT qd/ /L�� //�� 2 l (/J ((( �/ 1( p6 LD r ((( REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL W nn w, MING 6 MESH INSULATION/SOUND"/ W FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL