13296 (RR)Building
Address 48,-720 SSanisid
Owner Vance Simonds
Mailing 28752- Hina Vista
Address
City Zip Tel.
i,agta a Niguel, CA 92677 (
Contractor
ECkluad Roofing
Address
34--160 Linda Way
Z thedid1 •City; pC.A 92234 Tel. 321-0443
State Lic. .579664 City 124
& Classif. Lic. #
-Arch., Engr:,
Designer
Address _ Tel. _
City / 1 / Zlp- State
Lic.#
tJrLICENSEDyCONTR`AC�OR'S ECLARATION
Iereby'affirm that I'am licensed under�provlsions`Aof Chapter 9 (commencing with Section
7900) of Division 3 of the Business'andfProfessions/Code, and my license„`s i 'full force and
P.O. BOX 1504
78-105 CALLE ESTADO
ro LA QUINTA, CALIFORNIA 92253
N o . 13236
11LDING: TYPE CONST. ' OCC: GRP.
P. Number
!gal Description
oject Description Rert3Of '
Sq. Ft. No. • , No. Dw.
Size Stories Units ,4,
New ❑ Add ❑ "Alter ❑ Repair ❑ Demolition ❑
t• ..
fect.
SIGNATURE r - - DATE
ZONE:
OWNER -BUILDER DECLARATION
I hereby that I from the Contractor's License Law for following
Estimated Valuation $6000.00 '
affirm am exempt the
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
i -r•` -
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
PERMIT .r .` 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 Any Section 7031.5 by 'any 'applicant. for
-
Plan Chk. Dep.
alleged exemption. violation of a. permit
subjects the applicant to a civil penally of not more than five hundred dollars ($500). , i-
Plan Chk. Bal.
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will
_y...�,x” INSPECTOR
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
'Const. 3
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. 4-
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
-
Electrical
of proving that he did not build or improve for the purpose of sale.) , !S
O I, as owner of the property, am exclusively contracting with licensed conlractors.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. -
= such projects with a contractors) licensed pursuant to the Contractor's License Law.) _
-
_
Grading
❑ 1 am exempt under Sec. B. & P.C. for 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 Com egg tion Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company •
py is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) valuation -
or less.)
I certify that in the performance of the 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 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 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.
Signature of applicant Date
Mailing Address
City, State, Zip
TOTAL 30.00
Validation:
r
j> t ..
ZONE:
IQ B :A �
Minimum Setback tan s:
�'•
rout Sect�ba9ckfroqmm(� C nr
eL
_
rReamkQrom�ine
Line
Side Street Setback fer Line
I ide Setback from Prine
FINAL DATE
_y...�,x” INSPECTOR
Issued by
Permit
•�
Validated by:
'
Validation:
r
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
FOR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
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.COOL 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
SO. 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 APPJEOUIP.
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 2
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