11651 (SIGN)414 a
P.O. BOX 1504 N o . 11651
Building 78-105 CALLE ESTADO
Address 78--550 —11wv 111 LA QUINTA, CALIFORNIA 92253
Owner
MailiTng China Jo 1. ' BUILDING: TYPE CONST. OCC,. -GRP.-
Address 73091 Country Club ter. A-2 A.P. Number
City ZipTel.
Palm Desert, . A. 92260 340-4172 Legal Description
Contractor
Project Description 53,31
Fortune Signs Corp.
Address
2458 Led Ave.
City
Zip
Tel.:
S. El Monte, CA
91733
(818)579-9446
State Lic.
City
• & Classif. C45-608549
Lic. #
Sq. Ft.
No. No. Dw.
Size
Stories Units
Arch., Engr.,
Designer
New ❑ - Add ❑
Alter ❑ Repair ❑ Demolitions ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that am licensed under provisions of Chapter 9 (commencing with Section
7000) of Divislon 3 o the,Busines a d Professions Code, license in full
and my is force and
}
-• effect.
SIGNATURE " DATE
' OWNER -BUILDER DECLARATIONEstimated
I hereby affirm that I, am exempt from the Contractor's License Law for the following
Valuation
1 F 0 Q
1 00
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit toalter, improve, demolish, or repair any structure, prior to Its Issuance also
thconstruct,
requires e 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
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'aPlan
Chk. Dep.
subjects the applicant to a cavil penalty of not more than five hundred dollars ($500)..
I,
Plan Chk. Bal.
4,5.00
❑ 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
,
orImprovement 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.) ,.
❑ I, 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,I• •-
- such projects with a contractors) licensed pursuant to the Con tractor's. License Law.) -
Grading
❑ I am -exempt under Seca - B. 8 P:C7for this reason
Driveway Enc.
- Date owner
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 No. t• t .Company' C ^ 1 r 3`t"r.�
lecopy is filed with the city. O Certified copy is hereby furnished..
TOTAL
4-5.20
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
.(
•,,,, ,,,! ��lt �. .'2 ,d •f fjt.. it „#r.. ,.pp 16 �)
or less.)
A, , : , k c•'.. a. +... -. .
1 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'
ZONE: -
BY:
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 S tb k f C t L'
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 if 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, Stale, Zip
e ac . nom en er Ine
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from -Property Line
FINAL DATE INSPECTOR
Issued by:0 ' Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ FJ ®
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.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
IKITCHEN 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.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
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. REINF.
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/INITIALS
GARDEN WALL FINAL
Suaj'rE%-'rj'0 iNSTALLATOON AS PER
AND AL APPLICABLE CODES
DATE
BY
. cp �k JQ x�
FOOTUAMF 919AI-q
2458 LEE AVE, SO. EL MONTE, CA 91733
TELEPHONE: (818) 579-9446
FAX: (818) 579-0610
UL E105174
CONTACT PERSON : MICKEYWU
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LA
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DATE
ORBIT'— 'p. 1,44
CASE'No.
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on
Suaj'rE%-'rj'0 iNSTALLATOON AS PER
AND AL APPLICABLE CODES
DATE
BY
. cp �k JQ x�
FOOTUAMF 919AI-q
2458 LEE AVE, SO. EL MONTE, CA 91733
TELEPHONE: (818) 579-9446
FAX: (818) 579-0610
UL E105174
CONTACT PERSON : MICKEYWU
- -k- 1
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LA
tv
DATE
ORBIT'— 'p. 1,44
CASE'No.
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4179.7777-7
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