003376 (SFD)ng.
ess 7220 Trade.5t., Suite 100
Zip Tel.
SV Diego 92121
same
City Zip
I. State Lic.
Classif. 330551
'Arch.; Engr.,-- `
Designer
Tel.
Lic. #
Tel.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No.
003376
BUILDING: ,TYPE. CONST. OCC: GRP.
A.P.. Number. 774-£51»012
49-4:_84"Legal Description
Project Description Sinole Fa> ilv rw'?llit' n
Sq. Ft. 1338 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
GAR 422 .
"City
Zip
State
Ano 127s
»�
Lic: #
Front Setback from Center Line
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 full force and '
effect.
I hereby affirm that there is a construction lending agency for the performance of the
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Estimated Valuation,.
1 hereby affirm that I am exempt from the Contractor's License Law for the following
Lender's Name
reason: (Sec. 7031.5,Business and Professions Code: Any. .city or county which requiies a.
Lender's Address
This is a building permit when properly filled out, signed and validated,'and is subject to
.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
PERMIT
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
Issued : b
y
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 penalty of not more than five hundred dollars ($500).
-
Plan Chk. Bal.
O 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
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,
Mech. .
provided that such improvements are not intended or offered for sale. If, however, the building
Mailing Address
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 1, 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
❑ I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Infrastructure
n.t. nw„
WORKERS' COMPENSATION DECLARATION
rhereby'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. , O Certified copy is hereby furnished..
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i1 the permit is for one hundred dollars ($100) valuation
or less.) - • -
I certify that in the performance of lhg 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
TOTAL
REMARKS
I
AMOUNT
s
-1117(M
_ ..A 0A
9n! nA
s5s'1y i'..)"t J, tk '!4C,?'! <. !•,, .. S r f)� 1a.
NOTICE TO APPLICANT: If, after making this Certificate of Exemption * youshould become
ZONE:
BY: � �%j. % :, r hQ ,.," i, =:1.r ,.a41 i - ' !' a °, t : •
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 Setback Distances •-�
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
work for which this permit is issued. (Sec. 3097, Civil Code.)
Side Setback from Property Line
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated,'and is subject to
FINAL DATE
INSPECTOR
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.
Issued : b
y
Date Q/17/0 Permit
I agree to comply with all city and county ordinances and state laws relating to building
T-
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING9-EES
1ST FL. SQ. FT. p
2ND FL. SQ. FT. p
POR. SO. FT, p
GAR. SQ. FT. p
CAR P. SQ. FT- p
WALL SQ. FT.
SQ. FT. p
ESTIMATED CONSTRUCTION VALUATION
$
UNITS
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
$
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
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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. p c
BATH TUB
SQ. FT. p c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID p 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR p 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
{.,
I;;ROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL, AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
OR S PTI
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GA (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
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.—iZ
FRAMING
FINAL INSP.
ROOFING
�7+? Q
7F
/� -�'
•�'"
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
Li�_LATHING
MESH
iNSULATlONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
Inst'e[.Iuna ai�nri i untaiini i �r+I.a
GARDEN WALL FINAL