001787 (SFD)4
P.O. BOX 1504 No, 001787
Building54"'955 I�� $ LA QUINOTAC
Address CALIFORNIA 92253
Owner
esm—rim CWPMW
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address 75-M5 Caxfty aub Dr. A.P. Number
City JZip Tel.
-palm. 92260 568. 2$28 Legal Description
Contractor Project Description RIM WNW , 30 OR
t t 3 LaV4 and iJ7w" t
Address
City -- . Zip- . .Tel.' . -
Sam
saw
State Lic. City MM 2825
& Classif. Lic. # 329 Sq. Ft.No. No. Dw.
'
Size Stories Units
Arch., Engr.; 1'
Designer rixXt Mew= A."Oet New 2 Add ❑ Alter ❑ ' Repair ❑' Demolition ❑
Address Tel.
_. . _ - RM Aw.. - (714) 540--6117
City Zip State
cbstA " 92Qj6 Lic. # _. .
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing, with Section' v
7000) of,Division 3 of the Business and Profpssionss Code, and my licensee is inn''full,foorceand ,
.effect.
SIGNATURE _ /' DATE
f
OWNER -BUILDER DECLARATION Estimated Valuation 178A07.00 e h
I hereby affirm that am exempt from the Contractor's License Law for the following i�i7> V�•
reason: (Sec. 7031.5,Business and Professions Coder Any city or county -which requires a
permit torconsfruct, atter, improve, demolish, or repair any structure, prior to its,,issuance also AMOUNT
requires the applicant for such permit to file a signed statement that he -is licensed pursuant to PERMIT -
the provisions of the Contractor's License Law, tChapter 9 (commencing with Section 7000) -of
Division 30
1 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 PIan.Chk.'Dep. '
- 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 Plan Chk. Bal,;{ a I 529.10
do the work, and�the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.. ��}%}
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, Mech. G t9tl
provided that such improvements are not intended or offered for sale. If, however, -the building 5
t .00
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.) , Electrical }_ -.♦, 121,71
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 136.50
strucl the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law ,_ 32.316does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. �� J32.316
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
O I ain.exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date owner Infrastructure �t} .00
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
O Copy is filed with.the city. ❑ Certified copy is hereby furnished.
TOTAL 3,485.17
CERTIFICATE OF EXEMPTION FROM IREMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
-` W'EMU Vu "'L� •
or less.) --
certify that in the performance of thg work for whichthis permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
y
b.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
ZONE: BY:
subject to the 'Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
,Minimum Setback Distances:
Front Setback from Center Line '
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
Ihereby affirm that there'is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civi/ code.)
Side Setback from Property. Line
Lender's Name
Lender's Address
FINAL DATE INSPECTOR
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 certify that I have read this application and state that the above information is correct'
I
/Issued by: Date ermit_
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 in spection•paiposes.
Validated by:
�.✓"/� ,moi/��
Signature of applicant �T ` - a :' s_!t„�4 ' J Date'fr//
Meiling Address
Validation:
City, State, Zip
j
A31177 11 13 348517 CK.
' HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FFA90k
NO. PLUMBING FEES
IST FL. SO. FT. ®
2ND FL. SO. FT. ®
POR. SO. FT. ®
GAR. SQ, FT. ®
CAR P. I SQ. FT.
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUM
GY f •
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
GAS (ROUGH)
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.
SQ. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
ROOFING
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
ROUND PLUMBINGA%
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUM
GY f •
BONDING
HEATING (ROUGH)
a.
STORAGE TANK
FORMS
SEWER OR SEPTI
ROUGH WIRIN
DUCT WORK :
ROCK STORAGE
FOUND. REINF./�
GAS (ROUGH)
METER LOOP
HEATING (FIN L)
OTHER APP./EOUIP.
REINF. STEEL
GAS (FINAL �7
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
FINAL INSP.
FRAMING /
+f
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR..
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUNDS 8 J/
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL _.
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL