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PAT (12506) + BLCK (07344) + RPL (07217)44405 Marigold Lane 12506 07344 07217 t iBuilding Address Owner P.O. BOX 1504 44-465 Tkari old Lane 78-105 CALLE ESTADO J. LA QUINTA, CALIFORNIA 92253 ig and:Sudan 0"Brien Mailing r' Address Sam City Zip t Tel. . La Quinta;, 92253 _ .360-0921 Contractor Address Tel.: °= a BUILDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description Project Description Pa.ti0 Cover germuada Dune,-r+^ _ 92203 34.5-7228. State Lia & Classic B-1 501 -jj' ' City Lic. # 22 6 Sq. Ft. 200 Size _ _Arch., Engr.; - •..., , New ❑ Add ❑ Designer y` ' Address ;,,:, ,' Tel. City Zip:. - State i' Lic. # " - LICENSED CONTRACTOR'S DECLARATION '4 I hereby affirm thaY I am licensed under revisions of Chapter 9 (commencing with Section 7b00) of Divisio/ro3/of the Bsiness ofe ssions Code, 1 and and my license is in ffuulll force a c . fect. _ / J ... a f: -.icer !(> S JIG_ N ATUR.DATE i` OWNER pdUILDER DECLARATION Estimated Valuation is 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 i 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 PERMIT, " r Division 3 of the Business and ProlessioniiCode; or that. he is exempt therefrom, and the basis for the alleged exemption. Any violatiomrof Section 7031.5 by 'any applicant for a permit. Plan Chk. Dep. subjects the applicant to a civil penalty of not more than five hundred dollars ($500). - Plan Chk. Bal. ❑ I, as owner of the property, or my employees with wages as their sole compensation; win r do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.' 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, , Mach. 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 Electrical of proving that he did not build or improve for the purpose of sale.) O I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing. '_: 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 . .S. M. 1. ' such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - Grading Ij ❑ 1 am exempt under Sec. 8: & P.C. for this reason -Driveway Enc. Infrastructure 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.) Polic y,Nr9 ' "Company ' .. EJ'Copy is filed with the city.' ❑ Certified copy is hereby furnished. _ 4 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation kir or less.) s' ,rreI certify that in the performance of thg work for which this permit is issued, I shall not em'ploy'ariylperson in any manner so as to become subject to the Workers' Compensation Laws of California. •- -'tom.. • 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. 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 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. Signature of applicant _ Date' Mailing Address City, State, Zip S ;;'TOTAL -, REMARKS No. No. Dw. t: Stories >';- Units Alter ❑ Repair ❑ Demolition ❑ r f 4 r ZONE: BY: Minimum Setback Distances: Front Setback from Center Line , Rear Setback from -Rear Prop. Line - Side:Street Setback from Center Line - t Side Setback from Property Line ; FINAL DATE+` -# Issued by: at arm' Validated by:,.. Validation: ••r A.,tr Frr y $2,620,00" i AMOUNT c yy 54.00 i5V - f? _ Kn ZONE: BY: Minimum Setback Distances: Front Setback from Center Line , Rear Setback from -Rear Prop. Line - Side:Street Setback from Center Line - t Side Setback from Property Line ; FINAL DATE+` -# Issued by: at arm' Validated by:,.. Validation: ••r A.,tr Frr CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS COLL. AREA 1 ROUGH PLUMB. BONDING 2ND FL. SQ. FT. HEATING (ROUGH) YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. GAS (ROUGH) DRAINAGE PIPING WALL SQ. FT. HEATING (FINAL) DRINKING FOUNTAIN SQ. FT. ® GAS (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation WATER HEATER FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GRADING cu. yd. $ -Plus-x$-=$ GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM FINAL INSP. 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. ® c BATH TUB FIRE ZONE ROOFING SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/a c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac 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 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 APP./EQUIP. 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 l `l ll 11! any 4tL LAL REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL P.O. BOX 1504 Q Building78-105 CALLE ESTADO Address ' 44-405 hi igol'd,, ..- _a LA QUINTA• CALIFORNIA 92253 Owner .Windle i Mailing BUILDING TYPE CONST.' - - OCC: GRP.-•• Address 44-405liavigold. cac 's F1ovie' A.P. Number City „, ZiTel. _ - •j i.a ,Quinta _ • . . _ J.P3L 253 —13 9 Legal Description . Contractor Project Description 6 -foot x 163-fdot wden wa1'1' Address 34147 Ave. Eu .City Zip Tel.: ' Yucaipa' ­i ' 92399 -State Lic. 3City 595527 • Sq. Ft. & Classif. .. ..•w., Lic. # - Arch., Engr., Size 'No. No. Dw: - Stories Units • -• ' Designerti .. New ❑ •' Add'❑ :` ` Alter ❑ Repair ElDemolition ❑ Address • - Tel- Y. City Zip State - • .. Lica# LICENSED CONTRACTOR'S DECLARATION I hereby affirm that l am,license%ynder provisions of Chapter 9 (commencingwith Section 7000) of Division of t hhq;pBu,ssi i•ness and Professions Cade; and my license is in) full force and ' 3u effect. •* c, t)r.1r Yr•-d il'?() _SIGNATURE 8 ;C - i / DATE ' f OWNEWBUILDER DECLARATION _ I hereby affirm that I am exempt from the Contractors License Law for the following ^ Estimated Valuation 200 _ SGM0 - •- - - reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires, a permit to construct, after, 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 PERMIT AMOUNT ' 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 Plan Chk. Dep. •, , subjects the applicant to a civil perWty of not more than five hundred dollars ($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 Professions Code: The Contractor's COr1St. 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 QQ - Mech. •- • or improvement is sold within one year of completion, the owner -builder. will have the burden Electrical - 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- Plumbing 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 S.M,I. such projects with a contractor(s) fcncensed pursuant to the Contractor's License taw.) - ❑lam exempt•under SecB. 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, or a certificate of Worker's Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company- ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL ;s7Z. Jb - CERTIFICATE OF EXEMPTION FROM - REMARKS - t WORKERS' COMPENSATION INSURANCE orless.)• -his section need not. be completed it the permit is for one hundred dollars ($100) valuation G•-"w- -• ^,-i,14y; 3 ? '., -!s ;.-_,+A,r •.3 r1s y:.y;.;' :r r.' I cern that in the certify 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: It, after making this Certificate of Exemption you should' become ZONE: BY: -• subject to the Workers' Campensaticn provisions of 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 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the .. Side Street Setback from Center Line work for which this permit is issued. (Sec. 3097, C&8 Code.) , . - Side Setback from'Property Line Lender's Name Lenders Address ;FINAL' DATE INSPECTOR y } ' / 0 . - 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. - Icertify that I have read this application and state that the7above 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 author. representatives^•of this city to enter the above. mentioned property for ins tion purpose Pce PrP •.. - .. .. ._ ti 'Validated by: - Signature of applicant Date' _.Mailing Address .,Validation:- t' City,. State, Zip _ CONSTRUCTION ESTIMATE NO. f ELECTRICAL FEES PLUMBING FEES IST FL SQ. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM F 2ND FL SO. FT. FORMS SEWER OR SEPTIC TANK ROUGH WIRING, MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CARP. SO. FT. GROUT WATER HEATER WALL SQ. FT. FINAL INSP. DRINKING FOUNTAIN. SO FT ® ATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ =$ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED VENTILATION LAUNDRYTRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING 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 LATHING SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® V4c 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 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 // ATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING v AL 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 T4-19 af 4 QUM& P.O. BOX 1504 Building 44-46 Marigold 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 vwrrcr Windle Mailing Address 44-405 Marigold City Zip Tel. .a Quintal 9 253 360-1063 Contractor F 5 F Pool S Address 804975 Indio € lvd. City Zip Tela State Lic. City & Classif. 496807 Lic. # 130 I Arch., Engr., Designer Address' Tel. City Zip State 1 .m Plumbing Lic. # I herebyy affirm.,that I am licensed under provisions of Chaptel'9,jc omm-e-kiting with Section 000) of Dlvislori3 of the Busines's and Professions e; and my license is in full force and 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, after, 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 the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or Division 3 or 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). ❑ 1, 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-buider will have the burden or proving that he did not build or improve for the purpose or 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.) ❑ 1 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.) 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 pemift is for one hundred dollars ($100) valuation or less.) I certify that in the performance of the 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: If, after making this Certificate or 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 -of this city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip No. 11LDING: TYPE CONST. OCC: GRP. P. Number Legal Description Project Description - Tract # 22982 Pool & Spa, 07217 Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. 144.0t! Mech. Z4. U " Electrical 1 .m Plumbing 27.00 S. M.I. >1-1 k Grading Date Permit Driveway Enc. Infrastructure Validation: TOTAL REMARKS 14 K4,J Lerr,ri X A -1 ­ 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 /0 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE / UGH PLUMB. y/ J BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. FORMS SEWER OR SEPTIC TALK ROUGH WIRING, MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL/ v / TEMP. POLE DRAINAGE PIPING CAR P. I SQ. FT. GROUT WATER HEATER WALL SQ. FT. FINAL INSP. DRINKING FOUNTAIN. FT ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FRAMING FLOOR DRAIN MECHANICAL FEES p l R/ WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTONDISH) APPLIANCE DRYER VENTILATION GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIRE ZONE ROOFING LAUNDRY TRAY AIR HANDLING UNIT CFM FIREPLACE 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 ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac 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 PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK ROUND PLUMBING UNDERGROUN A.C. UNIT COLL. AREA SLAB GRADE / UGH PLUMB. y/ J BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TALK ROUGH WIRING, DUCT WORK ROCKSTORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL/ v / TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. GRADING cu. yd. $ -Plus-X$-=$ LUMBER GR. FRAMING FINAL INSP. ROOFING p l R/ 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 1 4 4 Q" P.O. BOX 1504 Building 64"4t Afarigol Lane 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 - - La^s quints Associates Mailing Address 43-.875 Washington St. City Zip Tel. PD:92260 Contractor E.G. Williams Dev. Corp. Address State Lic. & Classif. I City Arch., Engr., Designer Address Tel. 933I9 Lic. # 1231 City Zip State Lic- # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section effect. of Division 3 of the Business and Professions Code, and my license is in full force and SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractofs License Law for the following reason: (Sec„ 7031.5,Busmass and Professicws Code: Any city or county which requires a pemrit-to constnrct, after. uWmve, demolish, or repair any stnxture. prior to its issuance also 'requires th® appfranI for such permit to file a signed statement that he is licensed pursuant to ... the provkbns o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) of 'Divisiorn 3 of the Business and Professions Code, or that. he is exempt there/loon, and the basis for' the alleged exemption. Any violation. o/ Section 7031.5 by 'any applicant for a permit ,.. Suti%eUs the applicant [o a civil penalty of not more than five hundred doff= (5500). ❑ I, as owner oMe 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, Busness and Professions Code: The Contractor's License Law does not apply to an owner of property who bW& or rmproves thereon and who does such work himself or through his own employees, provided that such krpmvements are not untended or offered for safe. 11, however, the budding 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 safe.) ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Prolessi ns Code: The Contractor's License Law does not apply to an owner of property who bufids or Improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Conlracrors License Law.) ❑ 1 am exempt under Sec. w• g 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.) Policy No Company n❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (Tft section need not be completed i/ the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: h, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith campy wmLm such Provisions or this permit shad be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lenders Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days_ I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives .of this city to enter the above. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, zip No. Q5'903 BUILDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description Phase 17 Lot 31 Project Description Plan 4B Cactus Fitter Sq. Ft. No. No. Dw. r ze 1887 Stories Units w Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk` Dep: Plan Chk. Bal. ' • . Z -494.40 9 p Const. 590,00 Meth. 53.50 Electrical - 113 all Plumbing 123.00 S.M.I. 6.23 •` Grading Driveway Enc. Infrastructure 2221 ca$ 5662 TOTAL s.. v _5 C T _ i—,(, FitMAFiKS .^ ;1t:efrt 2€l:t,:i wS1• i.: .e')ft- fk hh Ls'y {} 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 Propert y Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: FitMAFiKS .^ ;1t:efrt 2€l:t,:i wS1• i.: .e')ft- fk hh Ls'y {} 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 Propert y Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS A.C. UNIT COLL. AREA SLAB GRADE YARD SPKLR SYSTEM 2ND FL. SO. FT. HEATING (ROUGH) MOBILEHOME SVC. BAR SINK POR SO FT Q ROUGH WIRING. GAR. SO. FT. ® POWER OUTLET ROOF DRAINS FOUND. REINF. 6 GAS (ROUGH) ( 2O/ DRAINAGE PIPING CAR P. SO. FT. ® HEATING (FINAL) WALL SO. FT. REINF. STEEL DRINKING FOUNTAIN SO FT ® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation SERVICE FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER $ GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LUMBER GR. LAUNDRY TRAY AIR HANDLING UNIT CFM FINAL INSP. 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. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1% c SEWAGE DISPOSAL SO.FT.GAR ® VVac HOUSE SEWER GAR. FIREWALL GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE --JCONST. 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. 6 GAS (ROUGH) ( 2O/ ETER LOOP HEATING (FINAL) OTHER APPIEOUIP. REINF. STEEL GAS (FINAL) EMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM $ GRADING cu. yd. plus x$ =$ LUMBER GR. FINAL INSP. nn FRAMING /rr/ FINAL INSP. ROOFING lllLD/ V e z/ /g d✓l REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND jp q FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL