05953 (SFD)4
P.O. BOX 1504 No. 05953
Building%s—� a 5a13alya 7&105 CALLE ESTADO
Address LA 92253
Owner
Barzoa Dew. _
Mailing BUILDING: TYPE CONST. OCC: GRP.
A JJ.... .S ..
--"---05-113 YeMZ K(l. 9 L
A.P. Number
City
ip
T
eat City
92234
92234
773-9024-,
Legal Description
Project Description
Phace III Lot 21
PI= 2222 - Pare La Quinita
Contractor
Sam _
Address „
City
Zip
Tela
State Lic.
& Classif. 3V07?
City .
Lic: # 1219
Sq. Ft.
Size 2222
No. No. Dw.
Stories Units
"Arch., Eng.,
Designer.:
New-%] Add ❑
Alter ❑. - Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
s
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under Provisions of Chapter 9 (commencing with Section
.70pp) of Division 3 of the B4siness and Profe{ss'ons Code, and my license is�in full fo{rcee and
effect" s� err +1 E i 71 CS r�
'
'
y
SIGNATURE "" DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following1�
reason: (Sec" 7031.5,Business and Professions Code: Any city or county which requires a
permit to constrict, after, Improve, demolish, or repair any structure, prior to its issuance also
requires theapplicant for such perms to file a signed statement that he is licensed pursuant to
the provisions of the Contractors 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 five hundred dollars ($500).
❑ 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
Estimated Valuation
•
PERMIT
AMOUNT
Plan Chk. Dep.
'
Plan Chk. Bal.
a'
X11 41; ,
Const.
`ir ti
Mech.
- s
builds or improves thereon and who does such work hinself or through his own employees,
provided that such improvements, are not intended or offered for sale. ff, however, the building
Electrical
:.xU. 9
orImprovement is said 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.)
Plumbing
144.50
❑ 1, 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
S.M.I.
_
7.91,'
does not apply to an owner of property who builds or Improves thereon, and who contracts for
such projects with a contractor(s) 5ce nsed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec � B. & P.C. for this reason
Grading
Driveway Enc.
Date Owner
Infrastructure
2523.63
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 furnished.
n
TOTAL
1.9 ",G
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is /or one Hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg 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
REMARKSs
i l !s'S 4 4 f)
'
Date Owner
NOTICE TO APPLICANT: h, 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 orthisPermit Shall bedeemed revoked.
ZONE: - BY:
Minimum Setback Distances:
Front Setback from.Center Line
Rear Setback from Rear Prop. Line
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.)
Side Street Setback from Center Line
Side Setback from Property Line
Lender's Name
FINAL DATE
Issued by:
Validated by:
INSPECTOR
ra-1.6-89
Date 7 Permit
Lenders Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
1 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 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
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
E
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMSZZ
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. Sp. FT. ®
GAS (ROUGHa,2f,.>V;�)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL Sp. FT.
=$
LUMBER GR.
�7
cFINAL INSP `
RAMING 1// (2 �
!!!!
URINAL
Sp. FT.
J,,
ESTIMATED CONSTRUCTION VALUATION $
REMARKS:
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FIRE ZONE ROOFING
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
FENCE FINAL
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 I / at _ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBINGUNDERGROUND
A.C. UNIT
COLL. AREA
RADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMSZZ
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGHa,2f,.>V;�)
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.
�7
cFINAL INSP `
RAMING 1// (2 �
!!!!
FINAL INSP.
ROOFING
Vtoll),�
VENTILATION
J,,
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING
MESH
INSULATION/SOUND a •�•
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL