04196 (SATT)X41
P.O. BOX -1504
Building78-105 CALLE ESTADO
Address��"�. L•A'QUINTA, CALIFORNIA 92253
Owner ~
B°oTalf3vard Da'iolomw 3►' BUILDING:,.TYPE CONST. OCC. GRP."
Mailing
Address .777 si stM p suite 1•06 „ _ A.P..Number.. „ w ...413-790-002
t
City Zip Tel.
Orange 92M 714-:;5.47-0055 Legal Description • M
Contractor - Project Description Sur -it' inct ii o Pl An 2
Address
City' i
State Lic.
' & Classif. 462814
Arch., Engr., .
Designer =
Address
Tel.
City
Lic. #
Tel.
. a »�,Sq. Ft. „, s ��� No.
Size Stories
City- Zip I State
Lic. #
' 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 is in full•force and
effect.;:•" � f• ,�„�+` �t
i.
_ SIGNATURE DATE
ry -
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness 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 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) of
No. Dw...
Units ? ,
I New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT
$65,22S
Division 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
Plan Chk. Dep.
-
subjects the applicant to a civil penalty of not more than five hundred dollars (5500).
O I, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Bal. •
7 •'
Const.
44 i •
do the work, and the structure 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
Mech.
.3#3 o
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
Electrical
44 s 5
or improvement is sold .within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.).
O I, as owner of the property, am exclusively contracting with licensed contractors to con-'
Plumbing
7 . Uig '
struct 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.) •
O 1 am exempt under Sec. B. & P.C. for this reason
Grading
Driveway Enc.
Date owner
Infrastructure
'
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
O Copy is filed with the city. O Certified copy is hereby furnished.
1
TOTAL .
- .- $2 A Cia 1R 2 , .;; .-rv) 74
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE�rr•
REMARKS
p t4r a
r• d«t+ �. t ,i;, }3k" •',c �}-•y` �-t=: '1.••1! ^! '"f f j o M
(This section need not be completed if the permit Is for one hundred dollars (S106) valuation
or less.) ..
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.
4
Date Owner
• NOTICE TO APPLICANT. 11, 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.: -
ZONE: BY: -
Minimum Setback Distances: .. -
Front Setback from Center Line
Rear Setback from Rear Prop. Line
. CONSTRUCTION LENDING AGENCYSlda
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.) ,
.;r
Side Setback from Property Line
Lender's Name
" Lender'sAddress
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.
:_FINAL DATE `'
INSPECTOR «
+}
^ 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.
Issued by:
Validated by:
Date Permit
% n
Signature of applicant Date
Mailing Address
Validation:..
?
City; State, • Zip
WHITE , -FINANCE PINK --APPLICANT, GREEN. BUILDING,
- .s. r Jr_ a<.... a{. ;.iY�q.,.i r. ....... .n:f!':'--.. ~w:F:C
GOLDENROD'- ASSESSORS OFFICE HARD COPY - FILE j - -v
'"1.. ..... ,, ,.i r`.i. .+..F...,ti..3s�.-C„�...«i.,.«. :�... C:i•: ��` c.:\„�:fa..: �..�. ii .,. _'"i._}•�.. ._1 '..
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT rA S
UNITS
SLAB GRADE Z? Z
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. �
F RMS
SEWER OR SEPTIC -ANK
ROUGH WIRING -
MOBILEHOME SVC.
BAR SINK
POR SO FTat
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. Qt
. TEMP. POLE
GROUT
DRAINAGE PIPING
CARP. SO FT. rd
FINAL INSP.
WALL SO. FT. (d
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu. yd.
$ plus x$
_$
URINAL
SO. FT. d
FRAMING--�r�s
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION S
III
"
WATER PIPING
NOTE: Not to be used as property tax valuation
REMARKS:
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVARCOOL HOOD
SIGN
WASH ER(AUTONDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
SPARK ARRESTOR
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
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. Fr. RESID 1'A c
SEWAGE DISPOSAL
SO.FT.GAR 3:c
HOUSE SEWER
CERT. OCC.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.LEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING . . ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
OUND PLUMBIN9112�
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE Z? Z
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
F RMS
SEWER OR SEPTIC -ANK
ROUGH WIRING -
DUCT WORK
ROCK STORAGE
oUND. REINF. 2
le
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 x$
_$
LU BER GR.
FINAL INSP.
FRAMING--�r�s
FINAL INSP.
ROOFING
III
"
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
G�
MESH
S LATIONISOUND3.
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIAlS
GARDEN WALL FINAL