003547 (RR)T 4 4hf 4 Quwav
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 51-254 Aveuida CarzatkZ4 LA QUINTA, CALIFORNIA 92253
D3am Franco
Mailing
Address Saim
City Zip Tel.
La�Utta 92253
Contractor
L. A. Star VAof Covany
Address
2108 W. SImmoa Ave.
CityZip Tela
Loa Angeles 9£��7 213-292--8165
State Lic. City
& Classif. 349805 Lic. #
Arch., Engr.;
Designer
Address Tel.
City Zip State
Lic. #
_ LICENSED CONT'RACTOR'S DECLARATION
I hereby affirm that I am licensed under Provisions of Chapter (commencing with Section
7000) of Division -3 of the Busines?and Professions Code, and my license is in full force and
effect.
I SIGNATURE 7 , 7 DATE
OWN ER. BUILDER DECLARATION'
I hereby affirm that I am exempt from the Contractors 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
I 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
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
subjects the applicant to a civil penalty or 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 or 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-builderwill have the burden
of 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
O Copy, is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(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 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.
i
. Date ' " r ' ✓ net - • !
—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'intormation is correct.
I agree to comply with all city and county ordinances and state 1aws 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
HARD COPY
No. 003547
BUILDING: TYPE CONST.
A.P..Number 774-045-02.4
Legal Description
Project. Description
OCC: GRP.
ZONE:
BY:
Minimum Setback Distances:
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑'
Repair ❑ Demolition ❑
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Datei2_71slA7 Permit
Validated by:
Validation:
Estimated Valuation
$3,500
PERMIT.
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const. _
544.5b
Mech.
Electrical
Plumbing
S.M.I.
4
Grad inig
Driveway Enc.
Infrastructure
TOTAL
i;'•�; �)
REMARKS
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
Issued by:
Datei2_71slA7 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT. p
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APP.IEQUIP.
DRAINAGE PIPING
CAR P. SO. FT. ®
TEMP. POLE
WALL SO. FT.
GROUT
DRINKING FOUNTAIN
SQ. FT. @
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
=$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(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. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID Q 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR p 3/ac
HOUSE SEWER
INSULATION/SOUND
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.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.
FRAMING
FINAL INSP.
ROOFING
2
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
- SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL