04233 (GRES)Building
Address
Owner'
Mailing
Address
City
Contractor
Address
ii
•042~3
t,
P.O. BOX 1504
78.105 CALLS ESTADO
78 34�1Taira Cotta Ct.s LA QU,INTA, CALIFORNIA 92253
ulevard DeVelopMen t
771 S. Halm St' 0 S3uite 106
(Tt 1Zip Tel.
. 9,2 68 714-547-805
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number. 613-790-001
Legal Description it
Project Description 'B'uaiditttar i6 . Plan 3
City (Zip (State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that.l 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
effecL�L�,!
SIGNATURE' �. "✓+->•r 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
(Estimated Valuation $56,08
permft to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
PERMIT
City
Zip
Tel.
State Lic.
& Classif. 452814
City
Lic. # „ , „
Sq. Ft. 763 No. „ No. Dw.
Size Stories Units l' '
Arch., Engr.,
Designer
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
car as #_net aA
City (Zip (State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that.l 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
effecL�L�,!
SIGNATURE' �. "✓+->•r 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
(Estimated Valuation $56,08
permft to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
PERMIT
'IAMQUNT '
' the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 o/ the Business and Professions Code, or thathe is exempt therefrom, and the basis
for the Any Section 7031.5 by for
Plan Chk. Dep.
alleged exemption: violation o/ any applicant a permit
subjects the applicant to a civil penalty o/ not more than live hundred dollars (5500).
Plan Chk. Bal•+
,�,' _ .
❑ 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
COf1St.
Professions Coder 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.
Mech.
, .� 4,
provided that Such improvements are not intended or offered for sale. I/, however, the building
"
or improvement is sold within one year of completion, the owner -builder will have the burden
Electrical
o/.proving that he did not build or improve for the purpose o/ sale.) ,
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
6:5 40
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner o/ 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
Infrastructure
&A IV W V,4
xr�r -a c s J0. �Zmwu
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.
s
TOTALM�i9dwC►�
r�::t 1�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
„s 3 , f . ,},1 ' f'#••�7 "'"'•�+"' +i' _ + .r u,
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
h
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become
ZONE:
BY:
• subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
;Minimum Setback Distances: - ,
Front Setback 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
work for which this permit is Issued. (Sec. 3097, Civil Code.)
Side Setback from Property Line
Lender's Name
Lenders Address
FINAL DATE
INSPECTOR
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,
• I certify that I have read this application and state that the above information is correct.
Issued by:
Date Permit
I agree to comply with all city and county ordinances and state laws relating to building
t
-construction, and hereby authorize representatives.•of ,this city to enter the above•
mentioned property for inspection purposes.
Validated by:
-
Signature of applicant Date—
ate
Mailing
Mailing Address -
Validation:
City, State, Zip
WHITE -. FINANCE, PINK -'APPLICANT; GREEN - BUILDING,'GOLDENROD - ASSESSOR'S OFFICE, HARD COPY -.FILE f " f
CONSTRUCTION ESTIMATL NO. ELECTRICAL FEES NO. PLUMBING FEES
IST FL SO F1 rp $
UNITS
UNDERGROUND
A.C. UNIT
YARD SPKLR SYSTEM
2ND FL SO FT. e
ROUGH PLUMB
BONDING
MOBILEHOME SVC.
BAR SINK
POR
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
POWER OUTLET
ROOF DRAINS
GAR SO. FT. is
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
DRAINAGE PIPING
CAR P. SO FT. a
TEMP. POLE
DRINKING FOUNTAIN
WALL SO. FT. Q
SERVICE
FINAL INSP.
URINAL
SO. FT. (a
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
G Z./ I
llsi�
FLOOR DRAIN
MECHANICAL FEES
�
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
I ISIGN
WASHER(AUTOHDISH)
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, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATHTUB
SO. FT. c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID I V. c
SEWAGE DISPOSAL
L-AT10NISOUND 2—
SO.FT.GAR (g V4c
HOUSE SEWER
FINISH GRADING
FINISH
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 8 AIR COND. SOLAR
SET ACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE Z�Z ��
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
OUND. REINF./Z i(-4!:;$
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus xE
=$
LUMBER GR.
- FINAL INSP.F
G Z./ I
llsi�
FINAL INSP.
OOFING -
�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR -
AL
LATHING
MESH
L-AT10NISOUND 2—
FINISH GRADING
FINISH
FINAL INSPECTION 'J{
CJ
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATL°RESJINITIALS ,
GARDEN WALL FINAL