04896 (SFD)- , r ^,y3"tme
Address .:
City f
,417
State.Lic::'� 33�#� 7
& Classif.
Arch:,' Engr.,,
Designer
Address -
Project Description
Plop 2222, Phase I - Lot 1;
Lic. # Sq: Ft.
Size
New ❑
el.
22222
No. - a No. Dw_:
Stories Units
Add ❑ Alter ❑ Repair ❑ Demolition'❑
City a
Zip
State
Lic. #
•{ '"p Vis- eJ
10.
4
.•?r {.- '
r!sC_`'"f
I 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 i3 In full force and
\
z
,° ,.• , r,' -
•" -OWNER•BUILDER DECLARATION
- I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 703 1.5, Business and Professions Code: Any city or county which requires a
permit • to construct, after, improve, demolish, or repair any structure, prior 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, Chapter 9 (commencing with Section 7000) or
Division, 3 of'fhe 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 ($500).c
O I, as owner of.the property, or my employees with wages as their sole compensation, will
do the work ,-and -thestructure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The. Contractor's License Law does not apply to an owner of property who
builds or Improves. -thereon and who does such work himself or through his own employees.
that, such Improvements are not intended or offered for sale. If, however, the building
or improvement lslsold3wfthin one year of completion, the owner -builder will have the burden
of proving that he did nofbuild or improve for the purpose of sale.)
P.O. BOX 1504
M
}Building
,AddresS 49433
Serllrta to Court, LAQUINTACCCALIFORNIA 92253
Plan Chk. Dep.
,,Owner
Plan Chk. Bal.
• 307.64
CvOrISt.
- V 3.50
="♦� B4TCou
Development
Electrical
- > � �4
-
Plumbing
-' Mailing:,
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the;project. (See..7044, Business and Professions Code: The Contractor's License Law
does not apply to owner of property who builds or improves thereon, and who contracts for
such projects with a contrsctor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
-
S. M. 1.
BUILDING: TYPE CONST.
OCC. GRP.
.�Addressr'.. -;
`aw9tlr, f 7G Ei>ic .
A.P. Number 9Ct.t !k
QU 1 i3 - i
,City
Zip
;.
' ••
, c
clt$:`1E+3c�riii •City
922.34
JTel.
y771-9024
Legal Description
Policy No. • • company
O Copy is filed with the city. ❑ Certified copy Is hereby furnished.
Y
- , r ^,y3"tme
Address .:
City f
,417
State.Lic::'� 33�#� 7
& Classif.
Arch:,' Engr.,,
Designer
Address -
Project Description
Plop 2222, Phase I - Lot 1;
Lic. # Sq: Ft.
Size
New ❑
el.
22222
No. - a No. Dw_:
Stories Units
Add ❑ Alter ❑ Repair ❑ Demolition'❑
City a
Zip
State
Lic. #
'
I 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 i3 In full force and
\
z
SIGNATURE DATE
•" -OWNER•BUILDER DECLARATION
- I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 703 1.5, Business and Professions Code: Any city or county which requires a
permit • to construct, after, improve, demolish, or repair any structure, prior 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, Chapter 9 (commencing with Section 7000) or
Division, 3 of'fhe 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).c
O I, as owner of.the property, or my employees with wages as their sole compensation, will
do the work ,-and -thestructure 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 work himself or through his own employees.
that, such Improvements are not intended or offered for sale. If, however, the building
or improvement lslsold3wfthin one year of completion, the owner -builder will have the burden
of proving that he did nofbuild or improve for the purpose of sale.)
Estimated Valuation
M
-
PERMIT
-
s.: < AMOUNT
.. -
Plan Chk. Dep.
e
t • # ;'
Plan Chk. Bal.
• 307.64
CvOrISt.
- V 3.50
Mech.
t r 3'.provided
(110
Electrical
- > � �4
-
Plumbing
�}Q
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the;project. (See..7044, Business and Professions Code: The Contractor's License Law
does not apply to owner of property who builds or improves thereon, and who contracts for
such projects with a contrsctor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
-
S. M. 1.
r,
Grading
Driveway Enc.
Date owner
Infrastructure
2,523.63
? ' WORKERS' COMPENSATION DECLARATION '!
`• I hereby affirm that I have a certificate of consent, to'self-insure, or a certificate of
;.
' ••
, c
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. • • company
O Copy is filed with the city. ❑ Certified copy Is hereby furnished.
Y
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This, sect Ion need not be completed if the permit Is for one hundred dollars ($100) valuation
r or less.) ..
REMARKS
't�� ,t ti }♦r4`lr� � "rl` i E+a••' .f� � 4,r r: � 'ti x'V
E 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.
M
w
_ Date Owner'
_ . NOTICE TO APPLICANT: If,,;after making this Certificate of Exemption you should become
Z'subjecf to the•'Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY:
,
Mlnlmum Setback Distances: - -
Front.Setback from Center Line
Rear Setback from Rear Prop. Line
'
` 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.)
Side Street Setback from Center Line
Side Setback from Property Line
,Lender's Name
,Lender's -Address
FINAL DATE
INSPECTOR '
y 7i YF w
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..
1
• Signature of applicant Date
Issued by:
Validated by:
Date Permit
Mailing Address
Validation:
GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
_... .uf-. ,J.i .. r.,.�,w�.:..- t,.•,-.._ `a. :24-L,.- - - .- -
City, State, ZIp "
WHITE FINANCE PINK APPLICANT, GREEN - BUILDING,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
ISI FL SO Fl (a $
UNITS
SLAB GRADE
ROUGH PLUMB BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. a
FORMS
�C[
OR V ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT a
GAS (ROUGH) METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GARSO. FT. Cl
GROUT
DRAINAGE PIPING
CAR P. SO FT. tG
FINAL INSP.
WALL SO. FT. a
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
CU. yd.
plus xS
-$
URINAL
- SO. FT. ra
FRAMING `A 'J'z;
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
Q� r rj J/ ng
V v�
,
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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
FINISH GRADING
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESID 1l/. c
SEWAGE DISPOSAL
SO.FT.GAR 3/.c
HOUSE SEWER
GAS PIPING
PERM17 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 8 AIR COND. SOLAR
SETBACK
D PLUMBING - UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
�C[
OR V ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.� 3'" f T
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)? C/. EMP. POLE
7 a
GROUT
WATER HEACCCTTERIII
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
CU. yd.
plus xS
-$
LUMBER GR.
FINAL INSP.
FRAMING `A 'J'z;
FINAL INSP.
ROOFING >� ��
VENTILATION�/�
Q� r rj J/ ng
V v�
,
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR'
GAR. FIREWALL
LATHING 5 1
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESRNITIALS
GARDEN WALL FINAL