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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