9622 (SFD)c&ty,, 4
Building 78-675 Ciarnes Circle
Add ress
Owner
Mailing
Address 1021 Fji2_ctt_anchnry Rci
City lZip - ITel.
Contractor
Zip I Tel.:
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
State Lic. City
& Classif. B 2923954 Lic. # 1612
Arch., Engr.,
Designer
Address Tel.
City Zip State
I I 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.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm 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 pennit to rile 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 exenipt 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).
0 1, 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 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 safe. 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 safe.) .
b 1, 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 contractorls) licensed pursuant to the Contractor's License Law.)
0 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-insu re, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
0 Copy is filed with the city. .0 Certified copy is hereby furnished.
CERfIFICATE 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 thp work for which this permit is issued, I shall not
employ any person in any manner sd,as to become subject to the Workers' Compensation
Laws of California. ;r I-,,,,,,, / V, 4"Y
Date_!��-� �Owner 1-02 - ' ';'
NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should become
subject to the Work6rs' 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. 309 7, Civil Code.)
Lender's Nam
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. o
Signature of applicant -Dat&
Maili ' ng Address
City, State, Zip
No. 9622
BUILDING: TYPE CONST.—OCC. GRP.
A.P. Number
Legal Description Lot 721
Project Description Plan C-3
Sq. Ft. No.
Size 1927 Stories
No. Dw.
Units
New D Add 0 Alter 0 Repair 0 -Demolition 0
Estimated Valuation 105,733
PERMIT -
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
552.00.
Const.
660. 50
Mech.
60.00
Electrical
114.47
Plumbing
144.50
S.M.I.
7.42
Grading
Driveway Enc.
I.nfrastr6c.ture
2378.99
lWts in Vublls�
25.00'
rrilAiR7 lei
�4
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_Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
UNITS
COLL. AREA
2ND FL. SO. FT. @
YARD SPKLR SYSTEM
POR� SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. 0
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT. @
ROUGH WIRING.
DRAINAGE PIPING
WALL SO. FT. @
ROCK STORAGE.
DRINKING FOUNTAIN.
SO. FT. @
METER L60P
URINAL
ESTIMATED CONSTRUCTION VALUATION $
OTHER APPJEOUIP.
WATER PIPING
NOTE: Not to be used as proper(y-tax valuation
TEMP. POLE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DIS H)
APPLIANCE DRYER
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
POLF, TEMIPERM
LAVATORY
HEATING SYST�M FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. a c
BATH TUB
SO. FT. @ c
I WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. Fr. RESID @ 1 V4 c
SEWAGE DISPOSAL
FIREPLACE
SO.FT.GAR @ 3Ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERM FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT.FEE
SMIFEE PLUMB. FEE
STRUCTURE Z PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
c- f").
"NDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRAD9
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS e) �V
SEWER OR SEPTIC TANK-2ffl/,:r/
ROUGH WIRING.
DUCT WORK
ROCK STORAGE.
FOUND. REINF.
GAS (ROUGH)jj��qtc#
METER L60P
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
?-cu. yd.
$-plus-x$-=$
LUMBER GR.
FINALINSP. ti, Ila A14 -et
FRAMING 9 wh
FINAL INSP.
ROOFING W3101t
aAl
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LA191 9 10141,12 1
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTIOWAN�
. %I , \ �'Wf
CERT. OCC.
FENCE FINAL ::_jrECTOR'S
INSP SIGNATURESIINITIALS
GARDEN WALL FINAL