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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