9895 (SFD)Building
Address
Owner
77-205 Arteaga
Mart; Schiffoan
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address 757 F ftv ,1Z.Pcd-nd S o_p.t
City Zip Tel.
• Oakland. 94609 1 415--42S•-3247
Contractor
Address
48-551 9.1lepView Dr.
City Zip Tel.
Palm Desert 1 92260
State Lic. City
& Classif.530952 Lic. #
Arch., Engr.,
Designer
i
Address Tel.
3303 -
City (Zip I State
Lic. #
LICENSED CONTRACTOR`S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
:Mof Division 3 of the Business and Professions Code, and my license is in full force and
SIGNATURE DATE
OWNER43UILDEA DECLARATION
1 hereby affirin that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,11ilLmness and Protessians Code: Arty CRY or county which requires a
permit to constrict, alter, reprove, danoish, or repair any structure, prior to its issuance also
-requires the applicant for such permit to tie a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (cormrencng with Section 7000) of
Division 3 of the Business and Pmlessars Code, or Oral. he is exempt therefrom, and the basis
' for the alleged exemption. Arty viofafion of Section• 7031.5 by 'any applicant for a permit
'r. subjects the applicant to a civil penalty of not more Man 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
pro
fassierhs Code: The Contractors License Law`does not apply to an owner of property who
builds • or improves thereon and who does'such work hirsell or through his own employees,
•-provided that such irprovements are not ntendod or offered for safe. n, however, the building
of improvement is sold within one year of completion, the owner -builder w70 have the burden
of proving that he did not bold or irpmva fa the purpose of sale.)
❑ 1; as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec. 7044, Busress and Prclessiors Code: The Contractor's License Law
does not aj" to an owner of property who builds or irpmwes thereon, and who contracts for .
such projects with a contractor(s) licensed pursuant to the Contractors License Law.)
❑ 1 am exempt under Sec_ a. & 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
Workers 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 EI EMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be eom;)Wed O the perms far one hundred doDars ($100) valuation
or less.)
I certify that in the performance of U1p work for which this permit is issued, I shall not
employ any person in any manner so as to became subject to the Workers' Compensation
Laws of California
Date owner
NOTICE TO APPLICANT. 6, after malting this Ceirfxx to of Exemption you should become
subject to the Workers' Compensation provisions of Me Labor Code, you must forthwith
comply with such provisions or this pei it shag 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.)
Lenders Name
Lenders Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that 1 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.
06150
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number 631-771-028
Legal Description
Project Description 5F
jrT.
Sq. Ft. 4534 No. w 2 No. Dw.
Size Stories Units
New ❑ Add 0 Alter ❑ Repair O Demolition O
'WAL1. & POOL HOT INCLilM IN 'IRIS PEMIT
IEstimated Valuation - $326,340
- PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal
$ 919.13
Const.
1,434.00
Mech.
92.03
Electrical
1,.169.13
Plumbing
241.50
S.M.I.
22.59
Grading
20.00
Driveway Enc.
Infrastructure
6,000..00
1$10,148.65
TOTAL
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 DATEINSPEEC�TOR
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
'
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMSS
TANK ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. @
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. a
POWER OUTLET
ROOF DRAINS
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT.
WALL SQ. FT.
WATER HEATER
DRINKING FOUNTAIN
SQ FT ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
cu. yd.
$ plus xE
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
vv
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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
INSULATIONISOUND
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
ACK
UND PLUMBING UNDERGROUND
A.C. UNIT
COLL. AREA
8 GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMSS
TANK ROUGH WIRING
DUCTWORK
ROCKSTORAGE
ND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
P. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus xE
=$
LUMBER GR.
FINAL INSP.
vv
FRAMING Q/1j�
FINAL
FINAL INSP.
ROOFINGW" % � f%
/ n
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
ImE
UEVELIMIER's Mict
AUUREsst
'1TILI'1 UIC t
War Wvelupert
111111,E ur
AURICUL I URAL COMMISSIONER
ny 1�
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61v-J4z-nz91
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