08101 (AR)l
Building
Address
Ouvner
79-605 Conn Lane
Address ,......,. ..a _. _ _ _
Contractor
State Lica -__ __ (City
& Classif- - Lic. #
Arcn., tngr.,,
Designer
Address Tel.
City - Zip State
.Lic. #
•4* 4v Q'4
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA: 92253
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm�.hat I am licen under provisions of Chapter 9,(commencing with Section
7000) of Dlvision.3 of.the Bu ess and Profen ons Code, and my license is in full force and
eftect.
SION
Q> DATE
OWNEXIBUILDER DECLARATION
I hereby affiryn that I am exempt from the Contractor's License. Law for the following
reason: (Sec. 7031.5,Bualness and Professions Code: Any city or county which requires a
permit to -construct, alter, Improve, demofish, or repair any structure, prior to its issuance also
requires the applicant for such permit to fife a signed statement that he Is licensed pursuant to
the provisions .ofthe. Contractor's License'Law, Chapter 8 (commencing with Section 7000) of
Division 3 of the Business and Professlo'nsr 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
subjectsthe 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, Bussness 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. N, 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 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project._ (Sec. 7044, Business and Professions Code: fie Contractor's License Law
does not apply- to an owner of properly who builds or improves thereon, and who contracts for
such projects with contractor(s)licensed pursuant 'to the Contractor's License Law.)
❑ f am exempt under Sec. B. & P.C. forthis reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self insure, or a certificate of
Worker's Compensation.lnsurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit Is for one hundred dollars ($100) valuation
or less.)
1 certify that In the performance of°thg work for which this permit is issued, I shall not
employ any parson in any manner -so as to become subject to the Workers'' Compensation
Laws of California. .
Data Owner
NOTICE TO APPLICANT: If, railer making this Certilkate of Exemption you should become
subject to the Workers' 'Compensation provisions of the Labor .Code, you must forthwith
comply with suchprovisions or this permit shall bedeemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit Is Issued. (Sec. 3087, 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.
1 agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to ehter the above-
mentioned property for: inspection purposes.
Signature of applicant Date
Mailing Address
City,. State, Zip
BUILDING: TYPE CONST. OCC: GRP.
Number
Legal Description
Project Description
08101
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 6/13/9 ermit
Validated by:
Validation
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
i
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
87.7S
Const.
135.00
Mech.
Electrical
Plumbing
S.M.I.
.j4
Grading
Driveway Enc.
Infrastructure
TOTAL
$223.59 r-` �-
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 6/13/9 ermit
Validated by:
Validation
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. S
UNITS
COLL, AREA
2ND FL. SO. FT.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CARP. SO. FT. ®
DUCT WORK
DRAINAGE PIPING
WALL SO. FT. @
DRINKING FOUNTAIN.
SO FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
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
GRADING
cu. yd.
y plus xS
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
VENTILATION
FIRE ZONE ROOFING;
FIREPLACE
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. REBID a 1VA c
SEWAGE DISPOSAL
SO.FT.GAR @ 3Ac
HOUSE SEWER
SPARK ARRESTOR
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
R WIRING,
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE'
GROUT
WATER HEATE
SERVICE
FINAL INSP.
BOND BEAM
WATERS TEM
GRADING
cu. yd.
y plus xS
=$
LUMBER GR.
FINAL INSP:
FRAMING
/NAL INS
ROOFING
/
Q /C
(((
REMARKS:-
EMARKS:VENTILATION
VENTILATION
FIRE ZONE ROOFING;
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
J
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL