13083 (BLCK)i P.O. BOX 1504' No. 1,.3083
Building , 78-105 CALLE ESTADO
Address 78»'7th Sagebrush LA QUINTA, CALIFORNIA 92253 e '
Owner
data Anglin r _
Mailin 9BUILDING-- TYPE CONST. OCC^GRP.
'
Address i274 Headow Glen Way E. A.P. Number '
City . 1. . - Zip - - JTel.
Escondido.. CA -92 }26:
'Y.M ;• aIOCS wa3l5OQ�oProject Description
HatteyMsomry
,
Address 1
43-101 Port6la Space 64
City.= Zip' Tel
Pais 'DiseXt C 32260 ?,
State LlcCiiy� • a Ems* ,
& Classi 2 �t60S$t3� tic. # I / Sq. Ft. No., No. Dw. •,
Arch Engr;r .'' ✓� J Size Stories Units I
Designer ;, New ❑ Add ❑ Alter ❑ Repair ❑ Demolitori El
Address �,� Tel.
City f Zip State
'` • _ Lic. #
LICENSED CONTRACTOR'S DECLARATION +•
1 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 c
effect �•' " • ?•• 11 �., _
SIGNATURE• ""l. J-11 I DATE -
-� f•. ' OWNER•BUILDERDECLARATION ���
wlxhereby'affirm•that I am exempt from the Contractor's License Law for the to Estimated Valuation
reason:-'�(Sec.'s,70$1.5, Business and Professions .Code: -Any city or�county which requires a
-:pemiitdto'conslruct,`alfer, -improve, demolish, or repair any structure, prior to its fssuance also - • -
`�.requiies�the'applicant:lor such permit to file a signed statement that he is licensed pursuant to PERMIT ' ,AMOUNT
'-the_provisions`o/the.Contractor's License law, Chapter 9. (commencing with Section 7000) of
` - DiGision. 3 or'the Business and Pro/essi0 s :Code, • 0r that he is exempt lherelrom, and the basis - - k-
"' 'for. the'•alle ed'exem tion.' An violation of Section 7.031.5 b -an p Plan Chk. Dep.
-
g p y y y applicant lora ermil p `!
_ subject_" hP applicant to a civil penalty, of not more than five hundred dollars,(S 500). -
_ 'O.I, as owner of the property, -or my employees with wages as their sole compensation, will - Plan Chk. Bal. !� A
do'the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and r- Const. �J. riv
- -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 '
or improvement is sold within one year of. completion, the owner -builder will have the burden j 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. 1. .. 10such projects..with a contractor(s) licensed pursuant to the -Contractor's License Law.J - -
r-
❑ I am exempt under Sec. B. F P.C. for this reason Grading
Driveway Enc.
Date—Owner Infrastructure
WORKERS' COMPENSATION DECLARATION ="
hereby affirm that I have a certificate of consent to self -insure, or a certificate of ,
Worker''r Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) -
Policy o. ' Company
0py is filed with the city. ❑ Certified copy is hereby furnished.,
VVVVVV TOTAL 25.10:
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section meed not - be completed it the permit is for one hundred dollars ($100) valuation • _ 1
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not ' .�,� ��t�.�,{�d+$•"� },: -•-�' � ,�y c (x
employ any person in any manner so as to become subject to the Workers' Compensation —
Laws of California. • - - '
I Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY:
subject to .the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. - - '•��
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) _ Side Setback from Property Line -
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
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. Issued by: - Date Permit
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. Validated by:
r
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ, FT. ®
CARP. SQ. FT.
WALL SQ. 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
3
BOND BEAM 7 (�
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
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
I
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
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
3
BOND BEAM 7 (�
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 23 ✓
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL