05082 (SFD)T 0 0
4t�t 4 4a Q" -
P.O. BOX 1504
Building
Address Sb -dill Inverness LA QUINTACCALIFORNIA 92253
Owner � " ` .
Mailing
Address
City
Palm De 13
art 92260 569-2828
Contractor
L;ITy Zip Tela
State Lic. City
& Classif. .288130 Lic. # 328
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 16 licensed undedprovisions 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. ;
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,13usiless and Professions Code: Any city or county which requires a
permit to construct, after, improve, demofish, or repair any structure, prior to its issuance also
requires the appdcant for such permit to file a signed statement that he is licensed pursuant to
the provfsions of the Contractor's 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 app&armt to a civil parody 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
builds or irproves thereon mid who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. lf, however. the building
or improvement is sold 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.)
❑ 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 taw
does not appy to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) icensed pursuant to the Contractor's License Law.) ,
❑ 1 am exempt under Sec B. & P.C. for this reason '`y
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, labor Code.)
Policy No Company
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the peril is for one hundred dollars ($100) valuation
or less.)
1 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 Califomia, f; t
Date ` ' • t 4 Owner �l
NOTICE TO APPLICANT: If, after malmrg this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor .Code, you must forthwith
comply with such proir cions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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 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
z:
No. 45482
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number PGA West Phase 29A
Legal Description
Project Description F1titL 2 -HR
Sq. Ft. 1548 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
REMARKS [
#x{31? I A`7` 3.0�f..7(l..
IV +,".41i _t ir.�ltat, t t.:tit.lt:'a
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
12/27/88
Issued by: Date Permit
Validated by:
Validation:
Estimated Valuation
$108,545
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
%A
Const.
55.51)
Mech.
h . fill
Electrical
fa
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
ISA? 2€;;
TOTAL
Q2_9At_74
2 .').jj 1l
REMARKS [
#x{31? I A`7` 3.0�f..7(l..
IV +,".41i _t ir.�ltat, t t.:tit.lt:'a
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
12/27/88
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADEtgER
H PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT. ®
FORMS
OR S I K
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GA (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR: SQ. FT. ®
T P. POLE
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. ®
FINAL INSP.
WALL SQ. FT.
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
Cu. yd.
$ plus x$
=$
URINAL
SQ FT ®
FINAL INSP.
RAMING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
/
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
LAUNDRY TRAY
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
FINAL INSPECTION 7
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 GRADEtgER
H PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
OR S I K
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GA (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REIN F. STEEL
AS (FINAL)
T P. POLE
GROUT
WATER HEATER
ERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
Cu. yd.
$ plus x$
=$
LU ER GR.
FINAL INSP.
RAMING
FINAL INSP.
ROOFING
D
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
R. FIREWALL
of
THING �'-S
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION 7
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL7d
I