06022 (BLCK)Building 53-360 Ave Navarra
Address
Owner
r2au Stxaff in
Mailing
Address P.O. Box 457
City Zip
uul�c� 1,
g
P.O. BOX 1504 No. a602Z. t '
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
z,
BUILDING: TYPE CONST. OCC: GRP. -
Contractor
S"affin Development
Address .
0=6
City lZip Tela
& Classif. 539977 I Lic. #
Arch., Engr.;
Designer
Address Tel.
City IZip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of.Chapter 9 (commencing with Section
7000) of Division3 of the Business and Professiooiis,Cbde, and my license is in full.fo ce and
effect-
SIGNATURE
ffectSIGNATURE - .r•" .,i DATE
OWNERBUILDER DECLARATION
I hereby affirin that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8ss and Professions Code: Any city or county . which requires a
permit to construct, ager, improve, demo[sh, or repair any structure, prior to its issuance also
regtn6es the appfpnt for such permit to lie a signed statement that he is licensed pursuant to
the provslores of the Contractors License Law, Chapter 9 (commencing with Section 7000) of .
Division 3 o1 the Baseness and Professions Cade, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any vkdaWn of Section 7031.5 by 'any applicant for a permit
subjects the appffcant to a c" penally otnot 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 Contractors Lkmnse 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 irprove for the purpose of sale.)
❑ 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 brills 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 R. & P -C. for this reason
Date owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Cpmpany :I f�
❑ Copy is filed with the city_ ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed B the permit is for one hundred dollars (S100) valuation
or less.)
I certify that in the Performance of UV 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: ff after mating this Certificate of Exemption you should become
subject to the Workers' Compensation prowmons of the Labor Code, you must forthwith
comply with such pro wons or this permit shelf be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there isa construction lending agency for the performance of the
work for which this permit is issued (Sec_ 3097, Civi Code.)
Lenders Name
Lenders Address
This is a building permit when property 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 applicafion arM state that the above information is correct.
1 agree to comply with all city arld county ordinances arld state laws relating to building
construction, and hereby authorae representatives mf this city •to
enter the above-.
mentioned properly for Inspection purposes
Signature of applicant Date
Mailing Address
City,' State, Zip
A.P. Number 774-095--007
Legal Description
Project Description Ra rztlfafit%z `all
1' �vum. heigbt 150' length
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
Estimated Valuation
2250.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
�Uti
Mech.
Electrical
Plumbing
S.M.I.
.z L
Grading
Driveway Enc.
Infrastructure
i!
TOTAL
_.
REMARKS
:_.. 4A
_.:.
11 1 1'ult1Lf•._.. r .R'fa4:A -..
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 Permit
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. I 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.
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 V< c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
REMARKS:
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 APPJEQUIP.
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
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