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002193 (SATT)4 P.O. BOX 1504 Building 804.3 U B,LFAAQUINT Address A CALIFORNIA 92253 Owner Mailing Address 75-045 03WAM Club City Zip Tel. 92260 1 568-2828 - Contractor Natl Mft4. and Land Address. City Samir! Zip -Tela ' State Lic. & Classif.Lic. $$ � City # Arch., Engr., -• Designer Address Tel. No. 002193 BUILDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description Project Description PGA W= PIPM 2 B t . • , . . . . .. P19M 40 QR DM 3142 Sq. Ft. No. Size - RM 589 Stories New ©;• Add ❑ Alter ❑ No. Dw- Units Repair ❑ Demolition ❑ City Zip State Lic. # _ LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I em 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:' _ SIGNATURE + k DATE '.OWNER' BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's -License Law for the following reason: '(Sec. 7031.5,Business and Professions Code: Any city or county which requires a peimit to construct, alter, improve, demolish, 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 Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is -exempt theiefrom, and the basis_ for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the 'applicant to a civil penalty of not more`thanfiive hundred dollars ($500). ❑ I, as owner of the, property, or my employees with wages as their sole compensation, will do the woik, 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 improves thereon and who does such work himself or through his own employees, provided that such improvements are notintended or offered for sale. If, however, the building or improvement is sold within one year or completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) - O 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 Law- ' does not apply to an owner or property who builds or improves thereon, and who contracts for -such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 a exempt under.Sec. B. & P.C. for this reason Estimated Valuation Q [��f�•�� $ 7! - 'PERMIT - AMOUNT Plan Chk. Dep.- Plan Chk. Bal. .19 Cons t. MAO i© Mech. - 55.00 Electrical $� . Plumbing 140.W S.M.1.y$ 13 Grading Driveway Enc. _ Date owner Infrastructure 2,QOO.00 WORKERS' COMPENSATION DECLARATION ' I hereby affirm that I ha4e 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. ❑ Certified copy is hereby furnished. - TOTAL 3,580.17 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 tha 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 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 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 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 ,' +—tet Date' Mailing Address f City, State, Zip I HARD COPY REMARKS 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 Issued by: Date 1-10 86Permit Validated by: Validation: A 4 8 3 7 3 18 J 17 Ch CONSTRUCTION ESTIMATE Aft, IST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. SQ, FT. ® CAR P. SQ. FT. WALL SQ. FT. ® SQ FT ® ESTIMATED CONSTRUCTION VALUATION $ NO. ELECTRICAL FEF UNITS MOBILEHOME SVC. POWER OUTLET NO. PLUMBING FEES YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation COLL. AREA FLOOR DRAIN MECHANICAL FEES BONDING I WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GAS (ROUGH) LAUNDRY TRAY AIR HANDLING UNIT CFM OTHER APP.IEQUIP. 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 GRADING cu. yd. $ plus x$ SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL FINAL INSP. SQ.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING PERMIT FEE VENTILATION 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 APP.IEQUIP. 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 FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL