11202 (RPL)O�
P.O. BOX 1504 N o . 11202
Building78--815 Sanita Drive LA QUINTAC
Address CALIFORNIA 92253
Owner
Steve Barsamian
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address aF ME!
A.P. Number
City T a Quinta Zip 92253 Tel.
Legal Description
Cont actor Project Description
. a croson Construction, Inc.
Address Pool & Spa
68-805A Perez ltd #E9
City Zip Tel.:
Cat Citi 92234 324-1232
State Lic. City
& Classif. .42,3x 574127 p Lic. # 1D44 Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
CityJZip State
Lic. #
/ter LICENSED CONTRACTOR'SDECLARATION
11 hereby affil rm thaw am j ensed under provisions Ahaptei 9 (commencing with Section
.ZQ00) of Division 3iif the�B�us�iness a$nrd�.Profess)"ons Code„arid my license is' full force aannd
t\.SIGNAT_UR E' DATE
OWNER-BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following 13 0 700
• . reason: (sec. 7031.5, Business "and Professions Code:, Any city or county which requires a
permit to construct• atter, improve, demolish, or repair any structure, prior to its Issuance also
requires the applicant for such permit to rile a signed statement that he. is licensed pursuant to PERMIT 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 alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500). n • S
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. S 7 43
do the work, and the structure is not intended or offered for.sale. (Sec. 7044, Buisness and CODSt.
Professions Code:. The Contractor's License Law does not apply to an owner of property who 1 Cqp
builds or improves thereon and who does such work himself or through his own, employees,' Mech. 27 . 00
provided that; such improvements are not intended or offered for sale.. It, however, the building
or improvement is sold within one year or completion, the owner-builder will have the burden Electrical 4j u �Q
of proving that he did not build or improve for the purpose of sale.) - n
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 24. 00'
struct the project. (Sec. 7044, Business and Professions Code: The Contractors License Law
does not apply -to an owner of property, who builds or improves thereon, and who contracts for S.M.I. i , 4,,0
such projects with a contractor(s) licensed pursuant to the Contractors 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 Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy,d(No. companyrtryrt ►f! 1;1 f iYLrIy it 1. fl"`j.y�ic b! 4
❑'Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 343.85
CERTIFICATE OF EXEMPTION FROM REMARKS
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 or 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
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.) Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
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. 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. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
1POWEROUTLET
ROOF DRAINS
CAR P. SO. Fr. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SO 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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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
SPARK ARRESTOR
SO. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ec
HOUSE SEWER
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
01
01 /
V
�7 ,2 !✓
(/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION-
NSPECTIONCERT.
CERT..OCC.
FENCE FINAL
SECTOR'SIGNATURES/INITIALS
GARDEN WALL FINAL
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