04970 (SFD)P.O. BOX 1504
Building 5r':- 598 'Inverness LA QUINOTACCALIFORNIA92253
Address .
Owner _
Sunrise
Address 42—
city 2—City
Contractor
Address
Zip
State Lic.
&Ciassif• 23&130
Arch., Engr•,
Designer
Address
r1
No. 04970 '
BUILDING: TYPE CONST. OCC: GRP.
41v
ext tt to 200 A.P. Number PIMA Leath rihr;npt 27—AVY 7
Tel.
'��` Legal Description
Project Description P), cc 963 ,p) ., 90U
a
Tel.: •�-
City
Lic. # 328 Sq. Ft. 2596 No. No. Dw.
Size a . Stories' Units''
utyI Zip I State
Lic. #
r LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and.
effect k
SIGNATURE'- - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason[ (Sec 7031-5,Busness and Professions Code: Any city or county which requires a
permit to construct. alter, improve, derm*s h, or repair any structure, prior to its issuance also
requires the �PTcard for such permit to lie a signed statement that he is licensed pursuant to
the Provisions of the CenbacfGrs (cone Law, Chapter 9 (commencing with Section 7000) of
prison 3 of the Elan Ness and Professors Code, or that. he is exempt therefrom, and the basis
for the a/e9ed exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the icanIto a aN penally of not more than five hundred dollars (5500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is riot intended or offered for sale. (Sec. 7044, euisness and
` Professions Code: The Contractor's License Law does not apply to an owner or property who
builds or improves thereon and who does such work himself or through his own employees,
Provided that such irprovanonls are not Intended or offered for sale. If, however, the building
or irproranent is said wihih ane year of completion, the owner-buider will have the burden
of proving that he 6d not buil or improve for the purpose of safe.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec. 7044, Bushess and Rotessions Code: The Contractor's License Law
does not apply to an owner of property who bukb or improves thereon, and who contracts for
such projects with a contractor(s) bvensedpursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec w_ g P.C- for this reason
Date Owner
W6RKEAS' COMPENSATION DECLARATION
whe affirm that I have a certificate of consent to self -insure, or a certificate of
pensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company '
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section meed not be completed ff the pemaT is for one hundred dollars ($100) valuation
or liess.) .
1 certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manna so as to become subject to the Workers' Compensation
Laws of California
Late owner
NOTK;E TO APPLICANT: /, aftw mating this Certificate or Exemption you should become
subject to the Nbrkws' Compensation provisions of the Labor Code, you must forthwith
coney with such provisions or this perm[ 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, Oivif Code.)
Lenders 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.
1 certify 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
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
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
12 ta/83
Issued by:
Date Permit
Validated by:
Validation:
Estimated Valuation
SI7g
318
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
5 10
Const.
a . iij
Mech.
a 0
Electrical
113.ng;
Plumbing
11112,50
S.M.I.
12.57
Grading
Driveway Enc.
Infrastructure
S4,045.90
2,022.95
TOTAL
4 _ Ll !s
REMARKS
77
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
12 ta/83
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
FINAL) �/-i�
POLE
TW.POLE
DRAINAGE PIPING
CARP. SQ. FT.
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN
SQ FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.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 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
FINAL) �/-i�
POLE
TW.POLE
GROUT
WATER HEATER
ICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-x$-=$
LUMBER GR.
FINAL INSP.
RAMING ��
FINAL INSP.
FING S- Z
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
NSULATION/SOUND
FINISH GRADING
NIKNAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL:d
1