11568 (PC)a"
44
P.O. BOX 1504 No . 11568
Building 78-105 CALLE ESTADO
Address R --S-- LA QUINTA, CALIFORNIA 92253
Owner
Washington -Adams Partn trship
Mailing
Address 2377 Crenshaw Blvd., Suite 300
City Zip Tel.
Tortallica -905,01.
Contractor
I).asen C�.t&r�.s 1E3-II4,3c3r�sn
Address
39725 Garand Ln.. Suite R
City Zip' Tel.: '
Palm PF:Prtr_ 226 4=-24172
Statetic. City
& Classif. 620242 B Lic. # 2108
Arch., Engr.,
Designer MCG Architecilt
Address Tel.
13201 Von Karsten Ave. (714)5'53-1
CityZip State
n.,o..--I & Lic''. #
r Ll"NOrU GVN I MAV 1 VM"5 ULU LANAI ION
I hereby affirm that I am licensed under provisions oftChaliter 9r(commencing with Section
7000) of Division 3 of the Business and Professions Code;eand4y license is in full force and
effect. i 1 d`� _ /...r f .✓
VWNtN•tlU1LUtXLULANAIIVN
I hereby affirm that I am exempt from the.Contracti's License Law for the following
reason: (Sec. 7031.5,Susiness and Professions Code:,;Any city or county which requires a
permit to construct, alter, improve, demolish, or repaidany 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
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 of 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 pot 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 -builder will have the burden
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-
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
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description rPv-;m t ;
Sq. Ft. 696 No. No. Dw.
Size • Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$9.255.50
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S:M.I.
Driveway Enc.
Date owner I 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, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy o• Company
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 •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.
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= 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
TOTAL
REMARKS
AMOUNT
[6.35
117.00
.?
1.00
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: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ, FT, ®
CARP. SQ. FT.
WALL SO. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE '
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.
SO. FT. ®c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3Y.c
HOUSE SEWER
REMARKS:
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. REINIF. v�/�_
civ
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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
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/1NITIALS
GARDEN WALL FINAL
LA
�ry
CONVOIT1014A LLY
ACCE
-F ?
TO IN-1gF- - 2,o rnftg
-d f
B To
T STALLATION AS PER,
APIW'VED By PLANNING& DEVELOPMENT DEPARTMENT
e
.BY 0"e" DATE
EXHIBIT
CASE NO.
!AND ALL APPLICABLE S
DATE
.15
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2458 LEE AVE., SO. EL MONTE, CA 91733
TELEPHONE: (818) 579-9446
FAX: (81.8) 579-0610
UL E105174
CONTACT PERSON : MICKE'YWU
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