BLCK (11518)77305 Loma Vista
11518
P.O. BOX 1504 N.O. ` • 11518,
Building 77-305: L`c3 Vista 7&105 CALLE ESTADO r
Address = - :1.. -LA OUINTA, CALIFORNIA 92253
wrier
t'.herokee . HomeE
BUILDING:,TYPE CONST.
OCC: GRP.
Mailing
Address
A.P. Number -
City
Zip
Tel.
Legal Description
Project Description
Block wall
'Contractor
• vina Const.
,
Address
''
,4
74-055 Goleta
•
City'Zip
"
'
Tel.:
Palm. Desert
- 92260
340-0302
State Lic.
City
& Classif. ;. Sq.
62`'30 `"'
Lic. #
Ft.
-Size -
No. r . No. Dw.
Stories- Units
Arch., Engr.,
New ❑ Add'❑
Alter ❑. ' :'Repair ❑ Demolition ❑
Designer = .:
Address;
Tel.
City _
Zip
State r
Lic. #'/
LICENSED CONTRACTOR'S DECLARATION
sr
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70 Division of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
ti?
.,7
.SIGNATURE - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt -from the Contractor's License Law for the following
Estimated Valuation
reason: (Sec. 7031.5, Business: and.*Pro/essions 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
PERMIT
•*'' •. AMOUNT • ' '
' ` '
provls/ons of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
' Division 3 o/ the Business and Professions Code, or that. he is exerript therefrom, and the basis •.
for the alleged exemption. Any, violation o/ Section 7031.5 by -any applicant. for a permit , .
*7._ .
_Plan Chk. Dep.
- 1_.:
'subjects the applicant to a civil penalty o/ not more than live hundred doliars.($500).•<-
Plan Chk. Bal.
❑ 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
I
•Const.
n s
• _ 54y00
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. - ; '
- •'`
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 o/ sale.)
Plumbing', -
- .,
❑ 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
S.M.I.•••
_ -.30
does not apply to an owner o/ property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading
❑ 1 am exempt under Sec. B. ti P.C.,for this reason
Driveway Enc.
Date Owner
Infrastructure
• WORKERSCOMPENSATION DECLARATION
v .
• 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 '
. O Copy is.filed with the city.. ❑_ Certified copy is hereby furnished.
TOTAL
S4.30
REMARKS 1 ^
d
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSAT.ION INSURANCE..•
-
}`
- -
(This section need not be completed it the permit is for. one hundred dollars, (8100) 'valuation -
or less.) . 3 . f,. I.,-
I certify that in the performance of thg'work for which this permit is issued, I shall not
;
% °'ii»t ' t>iie
- employ any person in any manner so as to become subject to the Workers" Compensation
Laws of California. •. e- - , x y :`• `
I Date ` Owner
.Exemption.
NOTICE TO APPLICANT: Il; after making -this 'Certificate o/ 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 Sek tbacDi§lances :
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
whic
' work for h this permit -is issued: (Sec. 3097, Civil Code:). _ -
Side Setback from Property Line
Lender's Name
FINAL DATE
INSPECTOR
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. •
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 thebove
•a.
-
IT property for inspection purposes.
Validated by:
Signature of applicant Date
Mailing Address
.Validation:
`
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. @
POR. SQ, FT, ®
GAR. SO. FT. ®
CAR P. SQ. FT. ®,
WALL SO. FT. ®
SO. 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROCK STORAGE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
METER LOOP
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REINF. STEEL
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 ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
HOUSE SEWER
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 I/ 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
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 ` a
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 SIGNATURESIINITIALS
GARDEN WALL FINAL