002317 (SATT)Building
Address
Owner
Mailing
Address
City
44
P.O. BOX 1504
54-289 LA QUINTACCALIFORNIA 92253
Zip
fel.
09t:A
Contractor
icat
Address
SEM
City - Zip
State Lic.
& Classif. 28813
Arch:, Engr.-,
Designer
Address
Tela
City
Lic. # 328
Tel.
No.. 002317
BUILDING: TYPE CONST. OCC. GRP. '
A.P. Number
Legal Description
Project Description PGA WIWI PLAN 3 OR
phase 5 A
DM 1627
Sq. Ft. � �4 No. No. Dw.
Size Stories Units '
New DAdd ❑ Alter El Repair ❑ Demolition ❑
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. r �^ `
SIGNATURE ✓'.'� j` " '� I! DATE '
" I ' .. V OWNER,BUILDERDECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
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 statementthat he is licensed pursuant -to
the provisions of the Contractor's Ocense Law, Chapter 9 (commencing with Section 7000) of
PERMIT
'
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
Plan'Chk. Dep. '
subjects the applicant to a civil penalty of not more than'five hundred. dollars ($500). .-
.- Q I, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Bal.
Const.
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.
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
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.)
Plumbing
O 1, 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.I.,
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Seca B. & P.C. for this reason
Grading
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
A 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
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
G 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 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: 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.
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
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
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant• ~ 1," Date f'. Fri'
Mailing Address
City, State, Zip
HARD COPY
TOTAL
REMARKS
103,665.53
AMOUNT
364.19
443.50
34.90
67.41
87.50
7.18-
1,554.98
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
b
IssuedY�
Date - Permit
Validated by:
Validation:
A5.32.4
4 .21 2559%6 CK
CONSTRUCTION ESTIMATENO.
ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. Sp. FT.
POR. SQ. FT. ®
GAR. I� Sp FT ®
CAR P. SO. FT. ®
WALL SO. FT. ®
Sp 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
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP—
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR j HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER ] B.T.U.
SO. FT. ® c
BATH TUB
I
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
�2<<G OK T.6 �uen�,
SO.FT.GAR ® 3/ac
HOUSE SEWER -
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
1
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE J PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK i
f419ROUND PLUMBINC��
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
UGH PLUMB._ ` G
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS }
SEWER OR SEPTIC TANKOUGH
WIRING f $
DUCT WORK
ROCK STORAGE
?Q&OUND. REINF. i,
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP—
DO REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu.Y d.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
ft,CFRAMING 6 ;
LROOFING
FINAL INSP.
r,4G �C//
VENTILATION
�2<<G OK T.6 �uen�,
� C !.
�6 oto
REMARKS:
I
FIRE ZONE ROOFING
FIREPLACE A
SPARK ARRESTOR
GAR. FIREWALL
2L,it�LATHING S
MESH !
% INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL ,
1 UM'b 51GNA 1 UMtb11N111ALb,
i
GARDEN WALL FINAL