002600 (SATT)4 l�f�Gl�+ 1i/ •
P.O. BOX 1504 No. 002600
Address
Building 78-105 54-113 HM LA QUINTACL CALIFORNIA 92253
Owner
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address 75-005 COW*. C14D A.P. Number
CityZip Tel.
�a� ne— , I92260 56e_282,6 Legal Description
Contractor Project Descriptions PMM 12 A
mal
Address plo A 0
*=M
City . ..Zip Tel..
Sam I
State Lic. Cit
& Classif. 289138 Lic.# 328 Sq. Ft. �1018
4 No. No. Dw.
..Arch., Engr.,.
Size Stories -Units
Designer New ❑X Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'$ 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 is,in full force and
effect.
SIGNATURE DATE _ -
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractors License Law for the following 103665-50
reason:. (Sec. 7031.5,Business and Professions Coder Any city. or county which requires a 1{
peimlt to construct, atter, improve, demolish, or repair any structure, prior to its - issuance also'
requires the applicant for such permit to rile a signed statement that he is licensed pursuant 'to .ePERMIT AMOUNT'
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of .
'Division 3 of the Business and Professions' Code, or thathe isexempt therefrom,'and.the basis - .PlanChk. De
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for 'a permit p '
subjects the applicant to a civil penalty of not more than live hundred.dollars (8500). Plan ChkBBI395.60
❑ ,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 and 'Const. 485.50 gy
Professions Code: The Contractor's License Law does not apply to an owner of property .who MAO builds or improves thereon and who does such work himself or through'.his own employees, Mech. .�'�'di airs•/
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the, owner -builder will have the burden 'Electrical ?a�g
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 - 87.50
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.I. 8.30
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
.O 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date owner Infrastructure 1,805097
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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.. ❑ Certified_copy.is hereby. furnished.
TOTAL 2,891.56
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) valuation
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
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 Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front.Se.tback from Center.Line
Rear Setback from Rear Prop. Line
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.) Side Setback from Property Line '
Lenders Name
Lenders 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. Issued by: Date 9730—Kermit
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
bovementioned property for inspection purposes. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
A 6 4 2 8. 9 30 <691,56 ft
HARD COPY
CONSTRUCTION ESTIMATE "`
NO. ELECTRICAL FEE
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. 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
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
A AS (ROUGH) /n G
/ 0
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEOUIP.
LAUNDRY TRAY
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
SQ. 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
I&OROUND PLUMBING v•`3
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE /0'.I JAS-
0
ROUGH PLUMB1 y
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR SEPlit Ity
�+i(v�..TROUGH WIRING/ i/ ��
DUCT WORK
ROCK STORAGE
FOUND. REINF. /,, C
((�.—��-(
A AS (ROUGH) /n G
/ 0
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
PIONAL INSP.
�v
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ —plus—x$—
_ $
LUMBER GR.
INAL INSP.2 / g
r�
FRAMINGi 2 �� �/_
INAL INSP.
)A./ ROOFING OCCe '(� L�S
H
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH '
INSULATION/SOUND '
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
Cl.l VA J Jlun/i 1 unCJ/lnl 1IHLJ,
GARDEN WALL FINAL