002316 (SATT)Building
Address
Owner
Mailing
Address
44
P.O. BOX 1504 No. 002316
54-253 talk EM LA QUINTACCALIFORNIA 92253
. BUILDING: TYPE CONST. OCC: GRP.
75-00 Club Drive A.P. Number
CityZip Tel.
pa ... 92260 . 558��
Contractor
ma tsage- and Lmd
Address,.
Sam
City JZjp ITel.
State Lic.
& Classif.. 2 �
Arch:, Engr.,
Designer.
Address
City
Lic. # 32e
Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S 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. �....�.
Legal Description
Project Description PIM 3 4
5A
Sq. Ft. DrM 1627 No. No. DIN.
Size - MR .424 Stories I. - Units �
New Q:k Add ❑ Alter ❑ Repair ❑ Demolition ❑
�+
SIGNATURE. i r d".�`>�= �' "�-�` DATE
Fj OWNER -BUILDER DECLARATION
'"
I hereby'affirm that I am exempt7from the Contractor's License Law for the following
. reason: (Sec. 7031.5,Business and Professions Code: Any. city or county which requires ,a
permit, to construct, atter, improve, demolish, or repair`. any structure, prior. to its issuancealso
requires the.applicant'ror 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 therefrom," 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 than five hundred dollars ($500).. ' .. ..
❑ I, as owner of the property, or my employees with wages as their. sole compensation, will
Estimated Valuation
'
�,6����
PERMIT
AMOUNT
.
plan Cf1k. De p '
Plan Chk. Bal. ..
64.19
Const'
3� 50
do the work, 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
Mech.
34.00
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
Electrical
jj�. !�
or improvement is sold within one year of completion, ithe owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
Plumbing
n
817.50
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Seca 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.
7.18
such projects with a contractor(s) licensed pursuant to the Contractor's License LawJ
❑ 1 am exempt under Sec. B. & P.C. for this reason
Grading
-
Driveway Enc.
Date owner
Infrastructure
, ,}
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
. ❑ Copy is filed with the. city. ❑ Certified copy is hereby furnished.'
TOTAL
2,558.76
REMARKS
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 the work for which this permit is issued, I shall not
-
employany 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.
ZONE:. BY:
:Minimum Setback Distances:
Front.Setback 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
Lender's Name
FINAL DATE
INSPECTOR
q� �y
4.'! 21"'8
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
Issued by:
- Dateermit -
construction, and hereby authorize representatives sof this city to enter the above-
bovementioned property for inspection purposes.
mentioned
Validated by:
r.
Signature of applicant -Date
Mailing Address YValidation:
A 5 3 2 3.1
4 21 255&715 CK
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL EESAL
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT.
WALL SO. FT. ®
SQ. 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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
p,C I d w ,c ��'
SO.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
G GROUND PLUMBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. fj2,
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
OZ60UGH WIRING
DUCT WORK
ROCK STORAGE
R—L OUND. REINF. /O
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL a
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ —plus—x$_=$
LUMBER GR.
FINAL INSP.
/ FRAMING 0 a G /
0
FINAL INSP.
eV ROOFING
�—
p,C I d w ,c ��'
S' /C., r
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
�bLATHING
MESH
x/6INSULATION/SOUND Q
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
Cti 1 V n J .I umA 1 un EwiIYI I INLA.
GARDEN WALL FINAL
W/ A rp cywfAGL