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001939 (SATT)P.O. BOX 1504 No. 001939 Building O 5-572 Oak � LA QUINTAC Address CALIFORNIA 92253 Mailing Address 75" 05 ammtxv ClUb Fziw City Zip Tel. Palm Dewrt 92UO 568-'2828 Contractor %3ti %arid Mid Mitgage .Address . BUILDING: TYPE CONST. Vff OCC;'GRP. R-3 A.P. Number Legal Description Project Description S.F.D. VIM X=;T PUM 30. OR rai'€iP! City .. Zip Tel.. 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 • State Lic. City EIM 2825 Side Street Setback from Center Line - & Classif. Lic. # 328 Sq. Ft. GM 569 No. 1 No. Dw. Arch., Engr.; Size - Stories Units ' Designer r4beft Altev= ASSOC. New Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. 241 Raid x,11 Ave. (714) . 540 -SUi I certify that I have read this application and state that the above information is correct. Issued by: City State _ JZip 92676 Lic. # mentioned property for inspection purposes. LICENSED CONTRACTOR'S DECLARATLON . Signature of applicant -rI ✓, .� Date �f�/'6+/r'-'�,.. 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 force4nd Mailing Addres effect City, State, Zip f / - -SIGNATURE •I / DATE ' OWNER -BUILDER DECLARATION Estimated Valuation HARD COPY I hereby affirm that am exempt from the Contractor's License Law for the following tco�gf df yS" • reason: (Sec. 703 1.S,Business and Professions Code: Any city, or county which requires a .RlCi�3®'�eV permit to construct, alter, 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 PERMITAMOUNT 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 the Any Section 7031.5 by 'any for .Plan Chk. Dc p for alleged exemption. violation of applicant a permit ' subjects the applicant to a civil penalty of•not more than rive•hundred dollars ($500). Plan Chk. Bal. 529,10 ❑ 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 of offered fo�•sale. (Sec. 7044,,Buisness and COnSt. Q' . 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, Mech. 55.00 .„ provided that such improvements are not intended or offered for sale. Il, - however; the building or improvement is sold within one year of completion, the owner -builder will have the burden Electrical �� of proving that he did not build or improve for the purpose of sale.) . _ [1I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 136.50 struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law builds improves thereon, for S.M.I. - - does not apply to an owner of property who or and who contracts such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 12.36 Grading ❑ 1 am exempt under Sec. B. & P.C. for this reason Driveway Enc. Date Owner Infrastructure 2,000-00 WORKERS' COMPENSATION DECLARATION Ihereby 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. O Certified copy is hereby furnished. TOTAL 3.485.17 _ CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation - ' or less.) '- I•certify that in the performance of the work for which this permit is issued, I shall not P" AM SM WT FAIi C& Wdlb LISt W-1 employany person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become. ZONE: BY: - subject to the' Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. .Minimum Setback Distances: - ' . Front Setback from Center Line • Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line - I hereby affirm that there is a construction lending agency for the performance of the - work for which this permit is issued. (Sec. 3097,. Civil code.) . - Side Setback from Property Line Lender's Name Lender's Address FINAL DATE INSPECTOR This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days.�,.�$ I certify that I have read this application and state that the above information is correct. Issued by: Date Permit 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. Valedated by: Signature of applicant -rI ✓, .� Date �f�/'6+/r'-'�,.. Mailing Addres Validation: ' City, State, Zip f / ` ! A3534' 12 10 3485.1 % Ch HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL F9111111111, NO. PLUMBING FEES 1ST FL. SO. FT. ® UNITS COLL. AREA 2ND FL. SO. FT. YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CARP. SO. FT. @ DUCT WORK DRAINAGE PIPING WALL SO. FT. DRINKING FOUNTAIN SO. FT. ® HEATING (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GRADING cu. yd. $ plus x$ LAUNDRYTRAY AIR HANDLING UNIT CFM 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. SO. FT. RESID ® 11/. c SEWAGE DISPOSAL FIREPLACE SO.FT.GAR ® 3/ac HOUSE SEWER SPARK ARRESTOR GAS PIPING PERMIT FEE GAR. FIREWALL 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 1 ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS �(� SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF..STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR, FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES11NITIALS GARDEN WALL FINAL