07543 (SFD)Building
Address 74-$35 •Sandia
.-
`Owner' JH Pups
Mailing
Address.,I2525 Higb 81
City:, 4 Zip
• San Df eqo 9
Contractor
Aaaress
City; :•.= fr;'
State L•icaS
& Classf., 3106M
Arch., Engr:,
Designer,
Address:
City -
a
LICENSEI
I hereby affirm'that;l am'&ansei
7000) of Division•of the,8usiness
effect.•
p
City
Lic. #
Tel.
Zip. State'
Lic. #
CONTRACTOR'S DECLARATION ,
under provisions of Chapter 9 (coma
a`nd-•Professions Code, and my liter
P.O. BOX 1504 N Q 1 i 54.3:
�:.; 7&105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST: OCC: GRP..
A.P.Number . _ !6
*
de I
Legal Description Citi 'm Coags@ _
Project Description HOW PlAn
Sq. Ft. 33€ 6 No. No. Dw.
Size Stories - Units
New ❑ Add .0 Alter ❑
icing with Section
is in full force and -
Repair ❑ , : Demolition ❑
a.=:!
..
SIGNATURE' "�" A "F'7 -DATE
•`'OWNER•BUILDER
DECLARATION
(hereby
Estimated Valuation
affirm thatI am exempt from the Contractor's License Law for the following
1r94A239 �JAIf
=
reascn�(Sec. 7031.5,Business 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
•D
requires the applicant /or 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
Division 3 o/ the Business and Professions Code, or that.he is exempt therefrom, and the basis
- (or..tha alleged Any Section 7031.5 'any
-_
Plan Chk. Dep:' -
exemption. violation of by applicant for a permit
' subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
-..
Plan ��•
❑'r;'as owner of the property, or my employees with wages as their sole compensation, will
Chk..Bal. — - ,
' 'do.the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const. ( ♦ '�, L[S
Professions Code: The Contractor's License Law does not apply to an owner o/ property who
' builds or improves thereon and who does such work himself or through his own employees,
g ♦ .
Mech .
^ provided that such improvements are not intended or offered /or sale. I/, however, the building
or Improvement is sold within one year o/ completion, the owner -builder will have the burden
Electricals 9�i..
o/proving that he did not build or improve for the purpose of sale.)
» ❑ iTa. owner of the property, am exclusively contracting with licensed contractors to con-
ip p�
Plumbing • • ..-iih�!r ii;
1 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.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
-
-Grading
❑ 1 am exempt under Sec. - B. & P.C. for this reason
Driveway Enc.{ _
Date Owner
•Iflfrastructure 5s386.2
tON
L
WORKERS' COMPENSA710N DEC ARA
` I hereby affirm that I have a certificate offconsentitto s`et-insuye, or a certificate of
-
Worker's Compensation Insurance, ora certified opytither
aneof: (Sec 38=,Labor Code.)
Policy No. Com t€ �t
P Y
-
rt t { {
' ❑Copy is filed with the city. ❑Certified copy i� hereby furnished.
-- ^
f pp{{ 1
TOTAL $7,863.7F ry i0- �_.+✓r __ S , J
CERTIFICATE OF EXEMPTION FROM
,
WORKERS' COMPENSATION INSURANCE
.-REMARKS
�y (�
{79-
(This section need not be completed i/ the permit is for one' hundred dollars ($100) valuation
- i ie�lY�' � 9� hV47 1 '7 z 10
or less.)
.
I certify that in the performance of.lhg 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 o/ Exemptionyou should become
ZONE: BY:+ -y '
subject to the Workers' Compensation provisions o/ the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances: ,
Front Setback from Center Line
_ . r
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
Address
INSPECTOR
FINAL DATE INS
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.
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:
Signature of applicant Date'
Mailing Address
Validation:
City, State, Zip
"
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. ' SO. FT.
POR. SO. FT. ®
GAR. SO, FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO 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
GAS =(ROUGH)((dLD
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
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.
SO. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 1/ac
HOUSE SEWER
FRAMING
FINAL INSP. (`� /(,{ Ro LD
C `
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE LPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
ROUND PLUMBINt3�
UNDERGROUND
A.C. UNIT
COLL. AREA
p
SLAB GRADE f 9�
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
LIOSEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS =(ROUGH)((dLD
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEELS 9/f,0�
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. d Qd
FRAMING
FINAL INSP. (`� /(,{ Ro LD
C `
ROOFING �0 �O
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LAP %I G 8 L
MESH
INSULATION/SOUND a ' 40 L
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL ::d