07101 (RPL)Building 51_180 Palos&
Address
Owner
Rich Deponte
TWY� 4 4 Q"
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
mailing
Address 21Q5 Lancer Drive
City Zip Tel.
Modesto 75350 12U9-527-1111
Contractor
Address
City
State Lie. I City
& Classif. Lie. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lie. #
LICENSED CONTRACTOR'S DECLARATION
�. • ' I hereby affirm that I am licensed under provisions of Chpptar 9 (commencing with Section
7000) of Division 3 of the Business and Professions CRdydand my license is In full force al effect.
SiGNATl1RE DATE
OWNER -BUILDER DECLARATION
I hereby affifm that t am exempt from the Conlractoes License Law for the following
reason: (Sec. 7031.5,Buswass and Professions Code: Any city or county which rogL*es a
permit to consfnrcf, alfer, improve, demolish, or repair any structure, prior to its issuance aiso
requires the appNwnt for such pemHY to fits a signed statement Thal he is licensed pursuant to
the provisions of the Contractor's Licenso Law, Chapter 9 (commencing w+lh Section 7000) of
Division 3 of the BusMess and Professions Code, or thathe is exempt thwetrom, and Ou basis
for the alleged examption. Any vtulatlon of Section 7031.5 by any applicant for a permit
subjecfs the applicant to a civil paRafty of nor more than live hurrdred dollars (5500).
Erf,-as owner of the property, or myemplayeos with wages as their sale compensation, will
do the work, and the structure is not intended nr offered for Dale. (Sac, 7044, Brrisness and
Professlnns Code: The Cordracloes License Law does not apply to an owner of property who
builds orsrorovas thereon and who does such work himself or through his awn emproyaes.
provided that such improvements are not intended or offered for sale. IF. however, the building
or 6nprovemonf is sold within one year of completion, the owner -buckler wiil 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 Professinns Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason —
Date Owner _
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 certilled 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'COMPENSATIONINSURANCE
(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: 11, after makkry this Cerfrticate 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 sh4l be dsemad 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
expjration 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 folating to building
construction, and hereby authorlxe representatives -of this city to enter the above•
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
`1.
BUILDING: TYPE CONST.
A.P. Number
OCC. GRP.
Legal Description
Project Description
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
FINAL DATE
INSPECTOR
2/14/90
Issued 4y:
Date
Validated by
Validation:
Estimated Valuation
S rh� •�-��}}
1:i�1rVV
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
70,0
Const.
117.00
Mech.
30.00
Electrical
27.00
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
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
2/14/90
Issued 4y:
Date
Validated by
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES NO.
PLUMBING FEES
A.C. UNIT
HEATING (ROUGH)
DUCT WORK
HEATING (FINAL)
FINAL INSP.
GRADING
cu. yd.
$ -Plus-)C$-=$
$
UNITS
FINAL INSP.
FRAMING
1ST FL SQ. FT.
ROOFING
/
REMARKS:
YARD SPKLR SYSTEM
2ND FL SO. FT.
VENTILATION
FIRE ZONE ROOFING
IMOBILEHOME SVC.
BAR SINK
FIREPLACE
POR. SQ. FT.
SPARK ARRESTOR
POWER OUTLET
ROOF DRAINS
GAR. FIREWALL
GAR. SQ. FT. ®
LATHING
DRAINAGE PIPING
MESH
CAR P_ SQ. FT.
INSULATIONISOUND
DRINKING FOUNTAIN
FINISH GRADING
WALL SQ. FT. @
FINAL INSPECTION
CERT. OCC.
URINAL
SQ. FT.
FENCE FINAL
INSPECTDR'S 51GNATURESIINITIALS
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
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
4TEMP
KITCHEN SINK
ABSORPTION SYSTEMB.T.U.
USE PERMIT SVC
WATER CLOSET'
POLE, TEMIPERM
LAVATORY
COMPRESSOR HP
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. Q c
BATH TUB
SQ. FT. ®c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 314c
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
SLAB GRADE
FORMS
FOUND. REINF.
REINF_STEEL
GROUT
BOND BEAM
GROUND PLUMBING
ROUGH PLUMB. 61
',4011,
SEWER OR SEPTIC TANK 101
GAS (ROUGH)
GAS (FINAL)
WATER HEATER
WATER SYSTEM
UNDERGROUND
ONDING
ROUGH WIRING
METER LOOP
TEMP. POLE
SERVICE
A.C. UNIT
HEATING (ROUGH)
DUCT WORK
HEATING (FINAL)
FINAL INSP.
GRADING
cu. yd.
$ -Plus-)C$-=$
COLL. AREA
STORAGE TANK
ROCK STORAGE
OTHER APPJEQUIP.
LUMBER GR_
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTDR'S 51GNATURESIINITIALS
GARDEN WALL FINAL