001898 (SFD)*hf 4
P.O. BOX 1504 No. 001898
Building LA QUINO
Address TA, CAL FORNIA 92253
�~ ��� '
Owner
BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address 75-005 omvftv Cl%b D.. A.P. Number
City . Zip Tel.
palm. '1 9XMD SU -2828 Legal Description
Contractor Project Description�i 2� A
Address.
Sam
City - Zip .. Tela
State Lic. City s 2596
& Classif. Lic. # 328 Sq. Ft. No. No. Dw.
Size - 577Stories 'I Units.
-
Arch.;�Engr.;.. .. _
Designer aD A.� ASWC. Newer❑ Add ❑ Alter ❑• Repair ❑ Demolition ❑
Address Tel.
2915 Pad H I1-Ailhe.. (7114) 5404317
CityZip. State
t� mesa9?. t % Lic. #
LICENSED CONTRACTOR'S DECLARATION_
I hereby affirm that I'am licensed under provisions of Chapter 9 (commencing with'Section�
7000) of Division'3 of the Business and Professions Code, and my license isinfull'fforrccee,and'
effect. f ... 'C s✓, .�//�I ;,I
.SIGNATURE- / i DATE
it OWNER-BUILOER DECLARATION s
r Estimated Valuation �� 73t .00
I hereby affirm that l am exempt"from the Contractor's License law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any.city or county which requiresa.
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also AMOUNT
requireselhe applicant for such permit to.file a signed statement that he is licensed pursuant to PERMIT - -• .�
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of z
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 Plan Chk. Dep. -
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). '
O I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk.,Bal. 495.15
do the work, and the structure is not intended or offered for sale. (Se6.•7044, Buisness and Const. �j$
Professions Code: The Contractor's License, Law does not apply to an owner of, property who •
00
builds or improves thereon and who does such work himself or through • his own employees, Mech. . - �{ �
.provided that' such improvements are not intended or offered.for sale. If, however,.jhe building
or improvement is sold within one year of completion, the owner -builder will have the burden 'Electrical J..t'B�7'
.06 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- Plumbing
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law - _ - ��32..54
does not apply to an owner of property who builds or improves thereon, and who contracts for $:M.L- .
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ Lam exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date owner Infrastructure 2,()00.00
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
❑ Copy is filed with the city. D Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for 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.
Date ' • Owner
NOTICE TO APPLICANT., If, 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 or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY r
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.). "
Lender's Name
Lender's 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.
I car tify.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 ,thiscity to enter the above-. /
mentioned property for inspection Purposes.
Signature of applican7r' Date//_/ //
Mailing Address
City, State, Zip
X
TOTAL 3,394.95
REMARKS
FW& AW WA MV PMW OF `11" PUVWX
110 BX= W
ZONE:
BY:
Minimum Setback Distances: _
Front Setback from Center Lirie `
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
' INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
A3183
11 13 33.5.4,95 CK
HARD COPY T
CONSTRUCTION ESTIMATE
, NO. ELECTRICAL FFdMkk
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO, FT, ®
POR.SQ. FT. ®
GAR. SO. FT. ®'
CARP. SQ. FT.
WALL SQ. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS. t� —'5r
[rte
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. @ c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL .
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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 PLUM Ell NG/�2 3
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS. t� —'5r
[rte
SEWER OR SEPTIC TSA( K'
ROUGH WIRY �� �j
DUCT WORK e��
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL�� j' gG
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
i
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
'
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
W/U Pm
LATHING
MESH
''
INSULATIONISOUN[
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INbrtc I Una awnA i UntWI NI i IALs,
GARDEN WALL FINAL