04165 (GRES)A
Building
Owner
Mailing
Address
City
Contractor
Address
P.O. BOX 1504
78-105 CALLE ESTADO
78-32,1, Terra,Cotta Ct, LA.CtUINTA, CALIFORNIA 92253'
7.77 S., Main St -
Zip
,Cie 92686
Swit" 106
Tel.
ll1445_40-8056
Q 4
I.
UILDING. TYPE CONST. OCC. GRP.:
.P. Number. ..613-190-00.1
egal Description
roject Description suildinq 9,r Plan I
City
Zip
Tel.
State Lic.
city
& Classif. 462-81t
Lic. If
Sq. Ft_ No. No. Dw.
I
Size Stories - Unit s
A rch., Engr.
'
Designer
New 0 Add 0 Alter 0 Repair 0 Demolition 0
'Address
Tel.
,; City,.
Zip
State
Lic. If
• LICENSED CONTRACTOR'S DECLARATION
I hereby aJlfjrm.thq!, 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 !,> • �/_ I , / X,
—
'SIGNATURE r' DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation $66032 ;1,.
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, prior to its Issuance also
requires the for such to file a signed statement that he is licensed to
PERMIT 'AMOUNT
applicant permit pursuant
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
'
PlanChk. Dep.
fortha'PIleg
subJectafheapplicant
'
as:ownerydt,the their
Plan Chk. Bal.
sole compensation, will
property, or my employees with wages as
'
do hawprk;`ariil"the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const. ptsProfa.osC
'
-
buI4ds.or,mp
I Mech. *UV
providd. that
or improvement is sold within one year of completion, the owner -builder will have the burden
Electrical
of proving that he did not build or improve for the purpose of sale.)
0 1; as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing %.J/ �i 111, 0U
strut(, 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
S.M.I.
•such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
0 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner
Inf rastructure
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
0 Copy is filed with the city. 0 Certified copy is hereby furnished.
TOTAL 4, i_4 `:A
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not.be completed if the permit is for one hundred dollars ($100) valuation
"61 f444*M_Q*P upw-571
f -W 011
• or less.)
I certify that in the performance of thp 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 _L�� Owner
NOTICE TO IAPPLICANT.- If, after making this Certificate of Exemption you should become
ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
Minimum Setback Distances:
comply with such provisions of this permit shall be deemed revoked.
Frotit Setb�a6k from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY.
Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the Performance of the
r
work for which this permit is issued: (Sec. 3097; Civil Code.) . . t 11 ':
—Side Setback from Property Line
Lender's Name
ti e
Lender's Address
.. .
FINAL DATEINSPECTO
This is a bull ding permit when properly filled out, signedand validated, and is subject to
-7-6/2'1/ YJ
expiration it work thereunder is suspended for 180 days.
7.,
I certify that I have read this application and state that the above information is correct.
'bounty
Issued by: Date Permit
I agree to comply with all city and
ordinances and state laws relating to building
I
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
WHITE - FINANCE, PINK - APPLICANT, GREEN -GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
BUILDING,'
A.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES.
NO. PLUMBING FEES
IST FL SO FT rp $
UNITS
AB GRADE �—
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. a
FORMS
SEW R
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT. a
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT.
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT. Q
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. Id
=$
LUMBER GR.
FINAL INSP wcu.
n
RAMING .�
17 14
URINAL
SO. FT. rd
(
666
ESTIMATED CONSTRUCTION VALUATION S
REMARKS:
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL MOOD
SIGN
WASHER(AUTONDISHI
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SPA ARRESTOR
LAUNDRYTRAY
AIR HANDLING UNIT CFM
EWALL
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
FINISH GRADING
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESID g 1 I c
SEWAGE DISPOSAL
SO.FT.GAR @ Ii c
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 PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUM ,
UNDERGROUND
A.C. UNIT
COLL. AREA
AB GRADE �—
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEW R
ROUGH WIRING
DUCT WORK
ROCK STORAGE
dQ
+� /
UND. REINF. /f7T
1 / ( v
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
NG
yd. '
s plus x2
=$
LUMBER GR.
FINAL INSP wcu.
n
RAMING .�
17 14
FINAL INSP,
FING /-- S— 59
(
666
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPA ARRESTOR
EWALL
MESH
OIgUtATIONISOUN D
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUSESIINITIALS
GARDEN WALL FINAL