05508 (SFD)4'4 a
P.O. BOX 1504 N o .
Idjng4 101 'Mita Cielo LA Q
I mess UINTA CALIFORNIA 92253
Abe $ Thalma Crosetn n
Mailing
Address 9010 Corbin Ave. S.3.
City Zip Tel.
I ftrthridae 1 91324 1 818/34
i James C. Cashman,
1 77-=200 Mmnesbta
State Lic. City
& Classif. B 195333 Lic. # 260 _
Arch., Engr.,
Designer
Address Tel.
City (Zip ( State
Lic. #
? LICENSED.CONTRACTOWS DECLARATION
lr hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7(100) Of Division 3 of the Business and Professions Code, and my license is infull force and
effect. r'
A"i�I°"f'f. r yt �.�1 l :e!r"'k'- j+•r�uwf./L... J./.fYr� ��/
SIGNATURE S f DATE
' OWNER -BUILDER DECLARATION' '
j 1 hereby affirm that'I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Ouslness and Professions Code: Any city or county which requires a
permit to construct, after, Improve, demolQh, 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 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 thealleged exemption. Any violation or Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty or not more than five 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 is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractors 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 safe. ft, however, the building
or improvement is sold within one year of completion, the owner -budder will have the burden
of proving that he did not build or improve for the purpose of sale.) „
❑ 11, 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) dcensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. Li P.C. for this reason
L
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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
i ❑ copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
1 WORKERS'COMPENSATIONINSURANCE
(This section need not be completed N the permd is for one hundred dollars ($100) valuation
or less.)
i 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-
Date-owner
aliforniaDateOwner
NOTICE TO APPLICANT: fl, after making this Certdirate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this pemi t shall be deemed revoked. .
CONSTRUCTION LENDING AGENCY
it 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 160 days.
I Car lity that I have read this application and state that the above information is correct
1 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
City, State, Zip
s
05508
BUILDING: TYPE CONST.
A.P. Number 617-640'057
Legal Description Lot 57
Project Description Plan 1.
OCC: GRP.-
Sy. Ft. 1852 ^ No.
Size Stories
No. Dw.
Units
New'."+❑ Add ❑ Alter ❑
Repair ❑ -Demolition ❑
Estimated Valuation $90,142.00
.PERMIT.
AMOUNT
Plan Chk. Dep.
Plan Chk. .Bal.
. T
Const.
Mech.#.
Electrical
107.28
Plumbing 1
132.5D
S.M.I.
�.
Grading
Driveway Enc.
Infrastructure
2,163.19
1 �
TOTAL
RLMARKS s�eR1� a tL+siat_Yi. Lrrdli`?4 ta12.Si "Y G)Pl '`? i 46't
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
3/14/89
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADEROUGH
PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL S0. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING,
MOBILEHOME SVC.
BAR SINK
POR. SO, FT. ®
GAS (ROUGH) 0
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I S0. FT. ®
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SO FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
ROOFING � %•Z �� f
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING V&I
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL 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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Va c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE tMECH.FEE
PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING/^ - ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUM IN
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADEROUGH
PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING,
DUCT WORK
ROCK STORAGE
02
FOUND. REINF.
GAS (ROUGH) 0
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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 Q FINAL INSP./` 1
ROOFING � %•Z �� f
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING V&I
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
�y
4,�
REMARKS:
SIGNATURES11NITIALS
GARDEN WALL FINAL