12697 (SFD)r
44
' P.O. BOX 1504
No. 12697
Building 53-445 A--vw. Vel.atr Co 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Own
Ea Quinta Desert Romp- Bldg. Group '
1 Mailing 16;J`+ h" buttau BUILDING: TYPECONST. OCC: GRP.
Address 5'2-990 Ave. €Dbragon A.P. Number 774--084 021'
CityZip Tel. Lot 10 Brock 226
La Winta, C� 92.253 (619) 771. 1775 Legal Description.
Contractor
tCL'el.ss. construction Project Description
Addre i§3s - -`" � - •
6 Reservoir Dr.
City Zip Tela
Norco, CA 91760 (909) 278-1504
State Lic.�2�05 City
& Classif. Lic. # Sq. Ft. 1870 No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter 'El Repair ❑ Demolition ❑ .
Address Tel.
City
Zip
State
ZONE:
-
Minimum Setback
Distances: i f
Lic. # '
Front Setback from Center Line
LICENSED CONTRACTOR'S DECLARATION
Rear Setback from Rear Prop. Line
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
Side Street Setback from Center Line
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
Side Setback from Property Line
• effect.
_SIGNATURE DATE
INSPECTOR
i
,
OWNER -BUILDER DECLARATION -
I hereby affirm that I am exempt from the Contractor's`License Law for the following
Estimated Valuation$107t$66.00
Date -Permit
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
Validated by:
permit to construct, alter, 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
PERMIT
AMOUNT
the provisions of the Contractor's 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 Any Section 7031.5 by 'any for
Plan Chk. Dep. 250.00
alleged exemption. violation of applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
Plan Chk. BBI.
149.89
❑ 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
Const.
�� 50
'Professions Code: The Contractor's License Law does not apply to an owner or property who
-
try
w
builds or improves thereon and who does such work himself or through his own employees,
Mech. -• -
• n
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
Electrical.
55.28
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
42.00
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does to builds improves thereon, for
1E A
not apply an owner of property who or and who contracts
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
.S.M.I.
A.� •. 7� _
20, t;►0
Grading _
❑ 1 am exempt under Sec. B. & P.C. for this reason
:00
Driveway,Enc.
Hata r,w or
Infrastructure -
2,377.97
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, 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 if the permit Is for one hundred .dollars -($100) valuation
or less.) t ---.
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.
Date Owner
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
-ftrra in FUDI Lc Places 25.00
rec se Plan. 25.00
TOTAL s •
REMARKS
-.3e408.43
�..t
ZONE:
BY:' '
Minimum Setback
Distances: i f
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
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
i
Y
ARD SPKLR SYSTEM
2ND FL. SQ. FT. p
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
FOR. SD. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
GAS (FINAL)
WALL SO. FT.
DRINKING FOUNTAIN.
GROUT
URINAL
SQ. FT. ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
cu. yd.
$ plus x$
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
7 �
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
VENTILATION
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
GAR. FIREWALL
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
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 i 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
A
SEWER
Gp
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE �-�(,� �Q Z
i
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
^
FRAMING is �
FINAL INSP.
ROOFING Q___olc/
7 �
/ /=
l..wa,_,
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING(`
FINAL INSPECTION ./1916
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUR_SIINITIALS
GARDEN WALL FINAL