03914 (SFD)1
P.O. BOX 1504
Buildin.. 78-105 CALLE ESTADO
LAQUINO3Address x"r '` . s "'•
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Owner
' - 'Dennis RickenbercrBUILDING: '
TYPE CONST. OCC. GRP.
Mailing
Address 7 73-24Rw019. - •^
*.^ • AiPrNumber••
City - Zip Te
e
LegaI DescrIption1GPalm
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Contractor Project Description R.y .Dwelling
.
Address J,
,City Zip. Tel.
W•
• State Lic.
City
& Classif. i *' _ •
Aa 7'it
Lic. # : '
c
S Ft. No. No.,Dw. "n
Q 1758
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Size " ^ '^ ' , Stories"' ^ Units
Arch., Engr., .
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Designer
Address
Tel.
City -
Zip
State '
q
Lic. # 4
.
' LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
' 7000) of Divisionof the Business and Professions Code, and my license is in full force and
.3
effect. ,
'
SIGNATURE DATE
OWNER -BUILDER DECLARATION
• I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
- -$93 50
- reason: (Sec. 7031.5,Business'and Professions Code: Any city or county .which requires a
permit to construct, after, 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
' •
PERMIT AMOUNT -
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
"`'+'°•r, :`^s„ -
• Division 30IF 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 (8500).
Plan Chk. Bal. •Y s a4' n
❑ 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 andAAy
' '
p Nrr
Const. , - 43,5900
. 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 not intended or offered for sale. If, however, the building
Mech.-+, - .00 '
Electrical; 83 '
-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.)
t35 '
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Plumbing ` c•. h f ♦CS 9 4r'
129141110.
❑ 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 of property who builds or improves thereon, and who contracts for
,
S. M. L' ,v 5 -
,
such .projects with a contractor(s) licensed pursuant to the Contractoor's License Law.)
V , - .
- . .
Grading ;,
❑ 1 am exempt under Sec.------.L—B. & P.C. for this reason
Driveway Enc.
Dale Ownerl'e6 -e¢.. ..1`-• ^adr4 r _ ..• ,r« xa
Infrastructure.;• :. A62.13.
v 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
y; ,
' ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL s
., '.
I
-CERTIFICATE OF EXEMPTION FROM
)
REMARKS _ -
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
"(CAW >tIIIIT # ' n• ' " 'Ve6 y.tj) , I
or less.)
I certify that in the performance of the 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
r
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
• r; ' .
' CONSTRUCTION LENDING AGENCY,'
Side Street Setback from'Center Line
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.) _ L
Side Setback from Property Line-
ine-Lender's
Lender'sName ,
;, .
Lender's • Address . • , .:.
This is a buildin g permit when properly filled out, signed and validated, and is subject to
FINAL DATE INSPE TOi
• 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. '
Issued by: Date Permit'
r.; 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. - .- - ..
-Validated by: - -
'
Signature of applicant Date
_
T Mailing Address '
Valldatlon:
til
City, State, Zip r
GOLDENROD ASSESSORS OFFICE HARD COPY.,- FILE x,y }°•-
: r^ •_ a.. °• yr {,t r' z_
i WHITE,f FINANCE PINK APPLICANT,'GREEN BUILDING,
•.. - - - t .r f , s .-
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIn,
ISI FL SO Fl (a S
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB
YARD SPKLR SYSTEM
2ND FL SO FT. S
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR SO FT 0
DUCT WORK
ROCK STORAGE
GAR SO. FT. Cr
POWER OUTLET
I ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SO FT. rp
GAS (FINAL)
WALL SO. FT. Q
DRINKING FOUNTAIN
GROUT
WATER HEATER
URINAL
SO. FT. td
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
cu. yd.
b plus xS
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTOKDISHI
APPLIANCE DRYER
// /" / /
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IZ
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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.
SO. FT. ® c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID g 1v: c
SEWAGE DISPOSAL
SO.FT.GAR (g 3/4c
HOUSE SEWER
INSULATION/SOUND
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 GRADE
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTI
+',
—y
V_ l
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
b plus xS
=b
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
// /" / /
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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