088125 - Madison Street - CVWD well site 6724MADISON ST WELLSITE 6724
08812
• r, P.O. BOX 1504 N6.
Building 78-105 CALLE ESTADO ti
Address T,tiraI I 4,164z 972A to m q4 Cf4ti _q+" QUINTA, CALIFORNIA 92253
Owner . r'
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te: BUILDING: TYPE CONST:`• OCC: GRP...
1 -Mailing
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Address PSG Box 1000 A.P. Number ~
City Zip Tel: ,
La, 0u$ic to 92253 345-28 Legal Description
Contractor Project Descriptiori .4040 of 4; ° 401 big h. Al ne-k Wall
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City
Zip
Tel.:
State Lic.
& Classif:- 551449V
City
# X33"
'133
, ^:
Sq. Ft. No : %? No. Dw.
Size Stones': Units -
' Arch., Engr.,
Designer Q
New ❑ Add ❑ .f •i. Alter,❑ Repair ❑ Demolitiori.❑ '
Address :.
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 Business and Professions Code, and my license is in fult.force and
effect.
- _ _ • - . - - " - -
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Y 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 tho 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 Sectiori X031.5 by 'any applicant for a permit
r
Estimated Valuatiow.'
-
PERMIT W • _ "- AMOUNT '
S ' • -
- Plan Chk. Dep.
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
_
Plan Chk. Bal..
Const: +
-
Mech.
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
Electrical• -
or improvement issold within one year of completion, the owner -builder will. have the.burden
of proving that he did not build or improve foathe purpose of sale.)
Plumbing
b 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. - . 77
. 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.)
O I am exempt under Sec. B. 8•P.C. for this reason
Grading ;
Driveway Enc.
Date owner
Infrastructure .
WORKERS' COMPENSATION DECLARATION
• I hereby affirm that l 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.)
" a n
..•:..i
Policy No. Company .
r..0 Copy is filed with the city. - ❑.Certified copy is hereby furnished.
v_ ,? r v , "ay
r + . P + j
TOTAL .17.
CERTIFICATE OF EXEMPTION FROM
- WORKERS' COMPENSATION INSURANCE
REMARKS
-
(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 lhp 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.
77
Date Owner'
NOTICE TO APPLICANT: If, 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.. • `
ZONE: BY:
minimum Setback Distances:
Front Setback from Center Line
Rear. Setback from Rear Prop. Line
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.),
Side Street Setback from Center Line -
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 it 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...
Issued by:- ' Date Permit
,
+'
Validated by:
Signature of applicant Date
Mailing Address
:-,Validation.
City, State, Zip
-.,.. .. iT+ 1 l.r.. ,t{ 2 5 3 S- { - +t `a -c`-5 a a a L - -[ - ).
A❖:
•4= {-'w ` ;2-.;e!:£ ti. a R)r-'C , ' yy '`. •. Y r
v s}: 3.' + f e. ;. -rat {i ,. '+, t.,• 1 ... ,
.. .; •-:. x 1?ti r,?i.. ,r:.. :i { fn"' ' -', _r. s , `},.- .. .' YY .1..'r•' L.3 -i •` _. A.x : 1 `
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. Sp. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
Sp 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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SO. FT. a c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/e c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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
G OUND. REINF. '-`G/-
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