10888 (BLCK)Budding 529760 OBRGGON
Owner
RAUL SAI TOS
Address SAME
City
LA . QUI IATA .
Contractor
�4AUL SAN TOS
Address
SASE
State Lic.
& Classif.
Arch., Engr.; .
Designer
Address
4
P.O. BOX 1504 l No. 10888
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Zip Tel.
9.2253. 564-3604 Legal Description
-- O I.ER Bi iLiiLR Project Description BLOCK • WALL
38' X.. 5 a
5.0' X.4'
Zip Tel.:
City
Lic. # Sq. Ft. No. No. Dw.
Size Stories • Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
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 Busin sand Professi ns Code, and my license is in full force'and
effect.' r'1
ice, �J' a _
- SIGNATLRE DATE
OWNER -BUILDER DECLARATION.* i Estimated Valuation '
I hereby affirm that I am exempt from the Contractor's License Law for the. following 1,
.reason /Sec 7031 5 Business and Professions Code: Any city or' county which re ukes a
4
permit to construct, alter, 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
-
PERMIT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 or the Business arid: 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.
suAfects the applicant to a civil penalty of not more than live hundred dollars (8500).-
❑ I, as owner of the property; or my employees with wages as their sole compensation, will
Plan .Chk: Bal.
. COrISt. '
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
builds of improves thereon and who does such work himself or through his own employees; .
Provided that such improvements are not.intanded or offered for sale. If, however, the . building'::
Mich.
Electrical '
or improvement is sold within one year of completion, the owner -budder will have the burden
. , of proving that he did not build or improve for the purpose of sale.) .. .
Plumbing-
❑ I, as.owner of the property, am exclusively contracting with licensed contractors to torr
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 bnproves thereon, and who contracts for
S.M:I. '
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
• =0,1 am exempt under Sec. B. 8 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, ora 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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff 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: B, 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. 309 7, Civil Code.)
Lender's Name
Lenders 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 Date
Mailing Address
City, State, Zip
AMOUNT
,i
$45.00.:
.20
TOTAL $45.20
REMARKS
!JVir ! a :iV4 f f3Tj44�. i fir_ Ar
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
Issued by: Date - Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE 166V
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
FOR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ, FT, ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEQUIP.
DRINKING FOUNTAIN.
SO FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE ' DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
GAR. FIREWALL
SQ.FT.GAR ® V4c
HOUSE SEWER
LATHING
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
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 166V
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS a
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 2
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION-
((( [[
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL