002476 (SATT)wwww
4
P.O. BOX 1504 No. 002476
Building 78-105 55�`�3t3 LA QUINTACp
CAL ALLE FORNIA 92253
Address
812=1 ' '
Mailing
Address 005 C -In Dr -
(TI
,#
City Zip Tel.
f � 9=0. 568,T-28-78
Contractor
. .. ftU Wig: mid S=d
Address
Sam
City lZipI Tel...
State Lic. I City
& Classif., 288130 Lic. # 32.8
' Arch:, Engr.,
Designer
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.. .4
SIGNATURE `L /- - DATE
OWNER,BUILDER DECLARATION
I hereby aifirm that I am exempt from the Contractor's License Law for -the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county..which requires a
permit to construct, after, 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
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). - '
O..I, as owner of the property, or my employees with wages as theirsole 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 not 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.)
O I, as owner of the property, am exclusively contracting with licensed contractors to'con-
struct the project: (Seca 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.) -
O 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. 3800, Labor Code.).
Policy No. Company
O 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 makingthis, 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 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 A .
Mailing Address
City, State, Zip
HARD COPY
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description �M` PEW 2 C
S.- Fe- De 14M 198 CR
3478
Sq. Ft. �- No. No. Dw.
Size Stories - " Units -
New OA Add O Alter O _ Repair ❑ Demolition O
Estimated Valuation .
2U.439.4'0
Minimum Setback Distances: -
PERMIT"',
Front Setback from Center Line
AMOUNT
Plan Chk. Dep.
250 AU .
Side Street Setback from Center Line
Plan Chk. Bal.
Side Setback from Property Line
343.98
Const..
INSPECTOR
713.00
Mech.
Validated by:
58.00..
Electrical
Validation:
140.73
Plumbing
A 6 0 9 5
1 4.50
S.M.I.
14.81
Grading
Driveway Enc.
Infrastructure
2,F00040
TOTAL
3.665.02 1
3.415.€32
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 7®23-SfPermit
Validated by:
Validation:
A 6 0 9 5
7 31 3415G,2 U
CONSTRUCTION ESTIMATE Mlk
NO. ELECTRICALdWS
NO. PLUMBING FEES
1ST FL. SO. FT. ®
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT. ®
OTHER APPJEQUIP.
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE:. Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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 SIGNATURESIINITIALS.
GARDEN WALL FINAL