002980 (BLCK)Buildin
Address 51-480 C&Ue Iloilo.
Owner
L. SMIbMd
Mailing'
Address Sam as Je
City Zip
La eta,. Ems. 92253
Contractor
- - /SUi1 '
P.O. BOX 1504 14U. u uz ua
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP. -
_ A.P_. Number"
I•
564-5085 Legal Description 13
Zip Tel.
Project. Description -n. Block- ISL
State Lic.
City
Minimum Setback: Distances:
& Classif.
Lic. ,)f
Sq. Ft.
No. No. Dw.
Side Street Setback from Center Line
Size
Stories Units
Arch.; Engr.,
New ❑ Add ❑
Alter ❑' Repair ❑ Demolition ❑
Designer
Address
Tel.
Validation:
City
Zip
State
Lic. #
- LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the, Contractor's License Law for the following
. reason: (Sec. 7031.5.Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, pnor to its issuance also
. requires the applicant for such permit to file a signed. statement that he is licensed pursuant to
the provisions: of the Contractor's License Law, Chapter9 (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
subjects the applicant to a civil penalty of not more than -five hundred dollars ($500).
• O. 1, as owner of the property, or my employees with wages as their sole compensation, wiu _
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness 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 woik'himself.or through his own employees, -
provided that such improvements are not intended or offered for sale. lf, 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)
Estimated Valuation
•' PERMIT.
: r+
—AMOUNT
Plan Chk; Dep.
-
-
Plan Ctik. Bal.
,
4 2.5.02
Const.
McCh.
Electrical
-
Plumbing
❑ 1, 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 builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) •
O I am exempt under Sec. B. & P.C. for this reason
S.M•l.
..
.�
Grading
.
Driveway Enc.
Date Owner
WORKERS' COMPENSATION DECLARATION
hhereby affirm that I'have a certificate of consent to self -insure, or a certificate of
vVorker's Compensation Insurance, or a certified copy thereof. (Sec. 3000, Labor Code.)
Policy No. Company
O Copy is filed with the city. , ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred collars (3100) valuation
-_� 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 Owrier
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions .of the - Labor Code, you must forthwith -
comply with such provisions or this permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY
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.)
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.
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.
Signature of applicant Date
Mailing Address
City, State, Zip
mmnu vvrT
Infrastructure
TOTAL 64.02
REMARKS
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 X9187- Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEE'S
1ST FL. S.O. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. SQ. FT.
WALL SQ. 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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
ROUGH PLUMB.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRY TRAY
AIR HANDLING UNIT CFM
_ a
v
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE,TEMIPERM
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 ® 11/4 c
SEWAGE DISPOSAL
BOND BEAM
SO.FT.GAR ® 3/ac
HOUSE SEWER
WATER SYSTEM
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
Aj 60UND. REINF.,l
_ a
v
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
G�
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
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