05822 (PLBG)T4hf 4 4 Q"
Building
Address 7;s-07 3 Mull("ei;sA
:N.C.R. ASSGC1AT1
Mailing
Address F.3. 111OX 513
City Zip Tel.
Contractor
Address
=3G-64,) ANr7,NTF 4i)
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City
Tel.
1.Z�
1.1DA DURES ^201
345-473
State Lie.
City
& Classif. T-122r35
Lie. #
Arch., Engr.,
Designer
Address
Tel.
City I I
Zip State
Lie. #
LICENSED CONTRACTOR'S DECLARATION
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.
5 ,NATI RE DATE
OWNEfSrBUILDER DECLARAT.ISII .
I hereby affirm that I am exempt from ;he Contractor's L(cerise) Law -for the following
reason: (Sac. 7031.5.Busires49 and Profesa'lons Code: Any efty�o wunly which raqukes a
perr"d 10 LLY!&fsocf, alter, improve, defr"sh, Or repair Any 511Ift�bfe, pder to is iswance also
fegldre.4 lf7e app&i'mnt for such panrdt to fife a signed statement that he is licensed pwsuanf to
dra prov�FJars bL the Contractors License Law, Chapter 9 (commehcft with Section 7000) of
Owsfan 3 of the Business and Prafosslons Code, or that. he is exempt rhererrom, and tha bads
for the alleged exompbon. Any vk9aWn of Section 7031.5 by any uppR-ant /or a permit
subjects the sppticanf to a cleat panafry of not more than five hundred domars ($500)-
l-1 1, as owner of the property, or my employees with wages as their sole compensation, witI
do the work, and the structure is not intended or ollered for sale. (Sec. 7044, guisfiess and
Profesakws Code- The Contractor's License raw does not apply to an owner of property who
builds or knpmves thereon and who does such work himsol or through his Own employees,
prnvkli,-d Ihaf such Improvemenfs am nor Mtended or offered for safe. 11, however, the building
or Improvemenf is said wiffin one year of comp)e1bn, the owner -builder *V have fhe burdsn
of promr9 that he did nal bull or mprove for the purpose of sale-)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Profmmbns Code: The Contractor's License Law
does nol apply ro an owner of property who builds or improves thereon, and who contracts for
such yrc,ec!, with a contractor(s) licensed pursuant to the Confractar'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. Mail, Labor Code.)
Policy No. Company
O Copy is filed with the city. ElCertified 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 Cif ifomia.
Date -Owner
NOTICE TO APPLICANT: M. after making this Cerbftafe of Exampfion you should become
subject to the Workers' Compensation provkjons of the Labor Cods, you must forthwith
comply with such provisions or Mrs 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. 3007, Civil Code.)
Lenders flame.
Lenders 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 stale 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 Lot this city to enter the above -
mentioned
mentioned property for ection purposes.
Signature of applicant Dam
Mailing Address_
City, State, Zip
No. 05822
BUILDING: TYPE CONST. OCC. GRP.
A.P. Numbe 69—OS2-004
Legal Description 7!'-073 XV-1- 7A TE jMYRA
Project Description'I'"�'�'FY
S,fprac SySTEjA VvJ7 6 �=
14- 61gA 1p DN
Sq. Ft. No. No. Dw-
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
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 DATE INSPECTOR
Issued by: Date Detroit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. Sp. FT.
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN.
BOND BEAM
WATER SYSTEM
URINAL
SO FT ®
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
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/. c
SEWAGE DISPOSAL
SO.FT.GAR ® V/ic
HOUSE SEWER
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. c
ROOFING
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