14646 (WALL)77445 Loma Vista
14646
La Quina,, a,, . Ch. .92253
Contractor
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gqddre
t�iSa,0 $�3nc�2"9s23ma Rd.
CAhedrai Citi zibA 92234 Tel
320- 9381
State Lic. City
& Classify; -19 437804 Lic. # 360'
Arch., Engr:,= '
. • •Designer .
BUILDING: TYPE CONST..'--= OCC: GRP.
A.P. Number
Legal Description. '
Project Description_ .330'--0f .6>t high Orahcia block.
gard®n wail,... 20 `" -of .2 1high garden: vall., ,
Sq. Ft.
Size • ..
Stories - -
No. Dw..
'. Units
New ❑ Add ❑', ':rr, Alter ❑ Repair ❑. Demolition p
Address Tel. ,
' City Zip State
Lic. # .
-LICENSED CONTRACTOR'S DECLARATION
I herebyyyyyy affirm that I.#m licensed under provisions of Chapter 9 (commencing with Section
7000)0E�iv
Business and Professions.Code; and my license is in full force and
effect
0
DATE .. .. - .. ..
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License law for. the following
Estimated Valuation'3 1 250.00
reason: (Sec._ 703 1.5, Business and.:Professions.Code: Any city,or.county which requires .a_
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permit .to construct, atter, improve, demolish, or repair, any structure, prior to its issuance. also. •-
,Plumbing
'
" ',requires the applicant /or.such permit to file 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 o the Business and Professions "Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation 7031.5 'any -
_
Plan Chk..Dep.
.' of -Section -by applicant -for a permit
-subjects the applicant to a civil penalty of not more than five hundred dollars ($500).• "- • .
Poljcy No. ... __C. pany '
,
Plan Chk. Bal.
O. I, as owner -of the property, or my employees with wages as their sole compensation, will . •
J/❑. Copy is filed with the city, . O Certified copy is hereby furnished.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
C t
Professions Code: The Contractor's License Law does not. apply to an owner of property who
OrIS .
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. 1/,'however, +the .building
or Improvement is sold within one year of completion, the owner -builder will have the burden
of proving thathedid not build or improve for. the purpose of sale.) ,.
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Electrical
,Plumbing
'
Ott, as owner of the property, am exclusively contracting with licensed contractors tocon-:
struct the project: (Sec. 7044, Business and.Professions -Code: The Contractor's.License Law •.
_
S.M.I.
does not apply to an, owner of.property,who builds or improves thereon, and who contracts for
' such projects with'a contractors) licensed pursuant to the Contractor's License Law.) ..
❑ I am exempt under Seca B. t. P.C. for this reason
Grading
Driveway Enc.
Date owner''
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate (if consent to self- insure;. or a certificate of.
Worker's Compensation Insuran, or acertified copy thereof. (Sec. 3800, labor Code.)
•.
Poljcy No. ... __C. pany '
J/❑. Copy is filed with the city, . O Certified copy is hereby furnished.
TOTAL
i 54.00
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE •
- (This sectlon'need not be completed I/ the permit Is for one hundred dollars (8100) valuation .
� ..
' . - . ..
or less.)
I certify that in the performance of thg work for which this permit•is.issued,'I shall not
employ any erson in any'manner so'asrto becometsubject to the Workers' Compensation •'
Lawyf S�IiJ"�
f:s
Date/ �St Owner ' /
"NOTICE TO
at
APPLICANT. g�after making this Certifice o1 Exemption' you. should become
"provisions
ZONE:
BY: -
sublect io the Workers' Compensation o/ 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
' WARNING: FAILURE TO SECUREWORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND.
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP. TO ONE '•
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO.THE COST OF COMPENSATION, ."
rte_ S'Ide. S T e-- t 'g ack -from Center Line
^
1 I..1 F 0 "de. Stuck bM Property Line
,':,
DAMAGES AS PROVIDED FOR IN SECTION.3706 OF THE LABOR CODE.: INTEREST; AND
II
ATTORNEY'S FEES.
I I
7ftis Is a tiuiidln g permit when properly filled out, signed and validated, and is subject to,.
expiration if work thereunder is suspended for 180 days.
FINAL.D E
I
NSP.ECTOR
'
I
r
. I certify that I have read this *application and state that,the above information.is correct: :. ',.:.Issued
b
Datl_J Permit
I agree to comply with all city.and county ordinances and'stateAaws relating to building
r- 1 ,
construction, and hereby authorize representatives :of this city• to enter the above:• r
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rf -
mentioned property for. purposes.:
.. _
Validated by-
r ,
Signature of applicant Date
Mailing,Address
Validation:
City, State, Zip
, 4
�/''.• �✓ -
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINMS`F-EES-
1ST FL. SO. FT. ® $
2ND FL. S0. FT. p
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. SO. 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
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 APPJEOUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SO. FT. ®c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
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
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL