12334 (SEW)IIIIIIIIIIIIIIIIIIIIIIIII 40
IE
Building
Address
54-420 Alvarado
44u
1rw
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Owner Eleanor Shive
Mailing
Address P.O. Box 294
City
La Quints, CA
Zip
92253
Tel. eid.3
564-4944
Contractor '
FSS Underground Construction
Ad3d8�s
/03 Vista: Drive
No. 12334
BUILDING: TYPE CONST. OCC: GRP.•
A.P. Number
Legal Description
Project Description Sewer Connect
Cit
athedral
Zip 92234
Tela
324-297
State Lic:'
& Classif:
C-42 482180
City 769
Lic. #
Arch., Engr
Designer
Sq. Ft.
Size
No.
Stories
No: Dw.
Units
New 0 Add 0 > Alter 0
Repair 0
'Demolition 0
Address
Tel.
it
c
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereb affirm that I am licensed under provisions of Chapter 9 (commencing with Section
t /7000) of t,_ Sion 3 of/She Businessland,Proleessions Code, and my license is in full force and
rt effect. skC/4F,/
SIGNATURE GATE
✓ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from 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, 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
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
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 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
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.)
❑ I, 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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. B & P.C. for this reason
Date - Owner
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.)
Polis .No -. Company
y is filed with the city. 0 Certified copy is hereby furnished.
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 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: Il, 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 iof this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State Zip
ti.�
Estimated Valuation $1,900.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical ''.,.
Plumbing
30.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
30.00
ZONE: •.. BY'
Minimum Setback:•Distances: _�
` ' Fcont Setback from Center Line
1
Rear
Side
Side
FINAL DATE
Issued by.
Validated by:
Validation:
i ,-
1
ac Rear FITtp. Li,
et S rom bbnte
•ack from Property Line
•
•
7
Date Permit
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
1ST FL
SO. FT.
SQ. FT.
SQ. FT.
SO. FT.
SO. FT.
SQ. FT.
SQ. FT.
VALUATION
®
$
STORAGE TANK
FORMS L
UNITS
0UGH WIRING
!
DUCT WORK
ROCK STORAGE
J
0
FOUND. REINF.
GAS (ROUGH)
r , ri '
2ND FL.
p
OTHER APP./EQUIP..
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
YARD SPKLR SYSTEM
SERVICE
FINAL INSP.
POR
p
WATER SYSTEM
GRADING
cu yd
MOBILEHOME SVC.
LUMBER GR.
FINAL INSP.
BAR SINK
FRAMING
FINAL INSP.
GAR.
®
ROOFING
REMARKS:
POWER OUTLET
VENTILATION
FIRE ZONE ROOFING
ROOF DRAINS
FIREPLACE
CAR P.
@
GAR. FIREWALL
LATHING
MESH
DRAINAGE PIPING
INSULATION/SOUND
WALL
®
FINAL INSPECTION,h�_93 (......e,
L�
CERT. OCC.
FENCE FINAL
DRINKING FOUNTAIN
GARDEN WALL FINAL
®
URINAL
ESTIMATED CONSTRUCTION
$
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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, TEM/PERM
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 fp 11A c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
L
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
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS L
SEWER ^o S PTI(` TANK
0UGH WIRING
!
DUCT WORK
ROCK STORAGE
J
0
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP..
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu yd
-_$
LUMBER GR.
FINAL INSP.
$ plus x$
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION,h�_93 (......e,
L�
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL