07544 (SFD)T4hf 4 44U&rw
P.O. BOX 1504
Building 79-825 Sandia 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
_--.._. J1 Petefs
Mailing
Address 22526 High Bluff
City Zip Tel.
San Diego 1 92234
Contractor
ress
City lZip
State Lic. ICity
& Classif. 320886 Lic. #
Arch., Engr.,
Designer "
Address Tel.
City ( Zip ( State
Lic. #
li LICENS�D CONTRACTOR'S DECLARATION
I hereby affirm'thgt, I anI'licensed under provisions of Chapter 9 (commencing with Section
7000) of Division?3 ofttthe BZl inessjand Professions Code, and my license is in full force and
effect
. t/4t tt E? f t_ . YF_-.,__
t OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
r9ason: (Sec. 7631.5,$usiness and Professions Code: Any city or county which requires a
permit to construct, alter, 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 or 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).
❑ I, 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 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. (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 contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSAk 10 D CLARATION
I hereby affirm that I have a certificate ofjico�sgn to sett Insure, or a certificate of
Worker's Compensation Insurance, or certified " t er ° (S a' 3800, Labor
Policy No. p Companyp r f#
❑ Copy is filed with the city. ❑Certi ledcopy i e @by f ru nished �f
CERTIFICATE OF EXE�PTION 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 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 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 -Date-
Mailing
ateMailing Address
City, State, Zip
No. 07544
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description Citrus Cwme
Project Description Model Plan 3C
ZONE:
BY:
Minimum Setback
Distances:
Sq. Ft.30o
Size
No. No. Dw.
Stories Units.
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date 113/00ermit
Validated by:
Estimated Valuation
? �247y394
PERMIT
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
683.82
Const.
Mech.
92-00
Electrical
Plumbing ." .
S.M.I. • ,
Grading
Driveway Enc.
Infrastructure
5.566.37
TOTAL
$3*U99.W1 $7994V=
REMARKS
10
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 113/00ermit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL SQ. FT.
POR. SQ. FT. @
GAR. SQ. FT. ®
CAR P. 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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
/i
GAS (ROUGH) Qf /(/ qd to
6l l
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
SQ. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ic
HOUSE SEWER
FINAL INSP.1� r AO T__.u.
i Y
ROOFING
7
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
pLUMBINGy
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADES �i �� %
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS s ��
SEWER OR SEPTIC TANK,3/
C1e70UGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
/i
GAS (ROUGH) Qf /(/ qd to
6l l
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
yd.
plus x$
_$
LUMBER GR.
FINAL INSP. Qdv
FRAMING `7l A G
FINAL INSP.1� r AO T__.u.
i Y
ROOFING
7
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
INSULATIONISOUND
(( [
FINISH GRADING
FINAL INSPECTION11 ! O
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL