07386 (RPL)P.O. BOX 1504 No. 07386
BuildinAddrress 5I-265 dal le PalomaLA QUINTACCCALIFORNIA 92253
Owner
Mi #ichel 1
Mailing BUILDING: "TYPE CONST. OCC: GRP. -
Address Same '
A.P. Number
City Zips Tel
L.e. Quint 92253 _ 4."$-�:&% Legal Description
Contractor Project Description Pf1t31 & Sna
A F Fools
Address
80-375 Indio Blvd.
City Zip -Tel.:
India 9201 345-5070
State Lic. City
& Classif. 476807 Lic. # 130 Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION .
1 he
affirm that-� licertsed;aiideGpro visions of &;;t&-9•(commencing with Sepfion
7000) ofDivisiorr3•of the &isiness,and'Pmfessions Code d my, license is in•fulbforce2nd"
effect. /� .�/.'�-..�!'_,�"P,..
_SIGNATURE✓ r .!, _ �JOe0KrE
.. ' LA
OWNEWBUILDthDECRATION Estimated Valuation y /��
1 hereby'affirm that I am exempt from the Contractors License Law for the following �i�SSiiiJ
reason: (Sec. 7031.5,0s6ness and Pharess ors lode: Any city or County which requires a
permit to construct, after, ingwove, demolish, or repair any structure, prior to its issuance also
requires the applicant for•such permit to Me a.signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions of the Contractors 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- My violation o1 Section 7031.5 by any applicant for a permit Plan Chk. Dep.
subjects the applicant to a civil penally of not more than rive hundred dollars {$500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. s l!
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Suisness and Const
Professions Code: The.Cootractor's License Law does not apply .
to an owner of property who ryry
builds or improves thereon and who Coes such work herself or through his own employees, Mech. b .. Ve�
provided that such improvements are not intended or.o9emd for sale - - It,, however, the building L�
or improvement is sold within aura year of canpietion, the owner -builder will have the burden Electrical 15.91)
of proving that he did of build or inwrove for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 2/7 .t,1t�
0.
structsthe project. (Sec. 7044, Busbess and Professions Code: The Contractor's License Law Y r._
does'not apply to an. owner of property who builds or improves1 thereon, and who contracts for S.M.I. .0
such projects with a contractor(s) 6cersed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec_ w, & 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
Workers Compensation Insurance. or a certified copy thereof. (Sec" 3800, Labor Code.)
Policy No. Company i-
❑ Copy is filed with the city. ❑ Certified.copy is hereby fumished.
TOTAL $334.3
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need of be caned it the permit is for one hundred dollars ($100) valuation `, ('WV > e' A") Iii ?94. S . A71— >0
or less.
I certify that in the performance of the work for which this permit is issued, 1 shall not 1.'ii' t,f�i:Tt-( ). F:J i t'FY,. -t �. • w'•?
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: 9, after nuft this Certdrate of Exemption you should become ZONE: BY:
subject to the Workers' Conversabori pvovsimis or the Labor Code, you must forthwith
Comply with such Provisions ur this: permit shall be deemed revoked. Minimum Setback Distances:
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. (sea. 3097, Cha Code.) Side Setback from Property Line
Lenders Name
Len Address FINAL DATE —INSPECTOR
Thishis is a building permit when properly'f'illed out, signed and validated; and'is subject to
expiration if work thereunder is suspended for 180 days. 3120/90
1 certity that I have read this application and state that the above information iscorrect. Issued by: Date Permit
I agree 4o comply with all city and county ordinances and state laws relating to building
construction, and hereby authorizerepresentatives orf 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
•
IST FL SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SO. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. I SO. FT. ®
GROUT
WATER HEATER
DRINKING FOUNTAIN.
WALL SO. FT.
FINAL INSP.
BOND BEAM
WATER SYSTEM
URINAL
SO. FT.
GRADING
cu. yd.
$ plus x$
=$
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
^� �
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
INSULATIONISOUND
SO.FT.GAR ® V4c
HOUSE SEWER
FINISH GRADING
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
^� �
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r
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL