003365 (SFD)No. 003365
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54-665 Carranza LA QUINTA, CALIFORNIA 92253
Owner
Mailing Marian WhitA BUILDING: TYPE CONST. OCC: GRP.
Address A.P. Number 774-274-041-9
City Zip Tel. "
Legal Description
Contractor _ Project Description SinnIA FAnmilyll inn
.
Address -
City
Tel.
-
92025
519-745-0881
State Lic.
City
& Classif.
Lic. #
Sq. Ft. 9?No.
'
No. Dw.
Arch., Engr., -.. -..
Size r
Stories Units
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
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 full force and
effect..
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I herebyaffirm that I from the Contractors License Law for the following
Estimated Valuation
$69
am exempt
reason: (Sec. 7031.5,Business and Professions Code: Any city or -county which requites a
'IM
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
-
AMOUNT♦
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
- •a•
'
Division 3 of the Business arid' Professions Code, or.that.he is exempt. therefrom; and the basis
for Any Section 7031.5 -'any fora
Plan Chk. Dep..
$250.00 -
the alleged exemption. violation of by applicant permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). "'
Plan Chk. Bal.
•. 40.63
D
❑ 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
- CO11St.
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..
-+�00
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
'Tj,�
.of proving that he did not build or improve for the purpose of sale.)
13f1, as owner of the property, am exclusively contracting with licensed contractors to con-.
Plumbing
103.00
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.
4,80 '
-such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O. 1
Gfading
20.
am.exempt under Sec. B. & P.C. for this reason
Jr
Driveway Eno.
20,0
Datelf?lZ r� Owner s t ^'t� r -
Infrastructure
1"015 r. 10
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.
TOTAL
1 11.90.5 1 11.550.63
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (3100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
* �•
.�t•�7a��..i�r
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
lt' CFtSF7 �Y�tt�t�. iY
Date Owner
_
NOTICE TO APPLICANT: If, after making this Certificate. of Exemption you should become
ZONE:
BY:
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
FINAL DATE
INSPECTOR
' This is a buildings 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 stale that the above information is correct:
Issued -by;
Date 9114/A3 Permit .
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.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
HARD COPY
ti
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
JGROUND
/ ROUGH PLUMB —�
YARD SPKLR SYSTEM
2ND FL. SO. FT. ®
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SQ. FT.
GAS (FINAL)
TEMP. POLE
WALL SQ. FT.
DRINKING FOUNTAIN
SQ FT ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
REMARKS:
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.
SO. FT. RESID ® 11/e c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
MESH
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
PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
JGROUND
/ ROUGH PLUMB —�
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
OUGH WIRINGJ;'� -c��
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.
�^
,3FRAMING -d — 1r"
264
I` tttJJJ
FINAL INSP.
ROOFING
4/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING
MESH
IWNSULATION/SOUND
FINISH GRADING
L
ev AL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL
9 1
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RELIABLE TRUSS, INC.
10375 BEECH AVENUE, P.O. BOX 1587 • FONTANA, CA 92335 • (714) 350-1050
PROJECT:
ROOF MATT: SCALE: E DATE: -
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PLAN:
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RELIABLE TRUSS, INC.
10375 BEECH AVENUE, P.O. BOX 1587 • FONTANA, CA 92335 • (714) 350-1050
PROJECT:
ROOF MATT: SCALE: E DATE: -
CO C, 71L- ��i�`1 G' DRAWN BY: 11`�� •i 1�
PLAN:
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1099CHAVENUE. P.O. BOX 1617O FONTANA. CA 0=6 0 (714) 364/060
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