03988 (BLCK)1 '
P.O. BOX 1504
Building 79-297 S, �t'4naet. 49,q k��A�QU9NTA CALIFORNIA 92253
' Address
Owner
Name; Co=ad `BUILDING: TYPE CONST. OCC. GRP.
Mailing.
'v.
.
Address
2C 1342
A.P. Number.
Legal Description.
Project Description
La 0ainta Pal'
V X 400 Pence
City Zip
9226-"°'Q
Tel. ,
,
Contractor
Address
City
Zip
Tel.
State Lic.
City
& Classif:
Lic. #
Sq. Ft.
No. No. Dw. S
Size
Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
• Address
Tel.
,
1 City --
Zip
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.
:.y'.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
«
. reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
PERMIT
- - AMOUNT, '
permit to construct, after, improve, demolish, or repair any structure, prior to Its issuance also
requires the applicant for such'permft 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
,
Division 3 of the Business and Professions Code, or that. he Is exempt therefrom, and the basis
for the„alleged Any Section 7031.5 by 'any for
Plan Chk. Dep.
exemption. violation of applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
Plan Chk. Bal.
-
O I, as owner of the property, or my employees with wages as their sole compensation, will
Const.
00
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
b
Mech.
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
-
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.)
Plumbing
- ..
I,Qas owner of,the property, am exclusively contracting with licensed contractors to con-
of
struct the. project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
S.M.I.
does not'apply to an owner of property who builds or improves thereon, and who contracts for
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 41.
Driveway Enc.:.
¢<s'
t fi{
Date' -.i'1r Owner' �".t t' `” ��•" -
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.)
t
f Policy No. Company
O Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL<;
REMARKS
" """' r K •, c ry a - •- . c" ;! V6d
CERTIFICATE OF EXEMPTION FROM-
WORKERS' COMPENSATION INSURANCE
'
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.) -
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
hof
.- NOTICE - TO APPLICANT. -,'If, after .making, -thls,. Certificate Exemption you 'should become
ZONE. -
BY: -
' subject - to • the Workers' Compensation provisions of the.. Labor Code, you must, forthwith
-comply with such provisions or this permit shall be'deemed revoked.' '
Miflimurn Setback Distances: �c ,
r
Front Setback'from Center Line
Rear Setback from Rear Prop. Line'
s '
•µ•coNSTRUCTION LENDING ACENcY
Side Street Setback from Center Line
-' 1 hereby -at Irm that there is a construction lending agency for the performance of. the
"work for which .thI permit Is Issued. (Sec. 3087, Civil Code.) '
'Side Setback'from'Property-Line '
` Lender's -Name i
t
Lenders Address
FINAL DATE'
INSPECTOR
'This is a•buildm g permit when properly filled out-signed:and validated, and Is subject to
- . ' _
expiration if work thereunder is suspended for 180 days. .
t±�«t t�jga
,77 JJ ` iY i7r
I certify that I have read this application and 'state that the above Information is -correct.--
Issued by:.
Date Permit
• .- I agree to comply with all city and county ordinances and state, laws relating to building
• construction, and hereby authorize representatives, of- this city' to' enter .the above.'
,
mentioned property for.inspection purposes. '
Validated by.
:
Signature of applicant Date
, +
Malling Address +•' -�
Validation:
'
r
City, State;;Zip
GOL09NN91D'- A$SE$SOR'S.OFFICE, HARD COPY; FILE
i... ait. .�-. ..l. .h: a..•a,csS .RrL.: ':r ,+s„.<[,.. r^.r};i�s '.iF'.'`".:as'-..✓-. ...Y` i4.�a..?' .i.r. ;,G ..... .-]C},'„1
WHITE L FINANCE PINKa APPLICANT GREEN -'BUILDING,
r -i• . .•.-_:"S, S..'i_et.-. lu._?iv r._r... _?:`':`.�t �.tnr...: i^..._:i
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO F1 (a S
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM.
2ND FL SO FT. R
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT liT
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. 1F
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT. 0
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. (a
=$
LUMBER GR.
FINAL INSP.
URINAL '
SO. FT ra
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
IWATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTONDISH)
APPLIANCE DRYER
FIREPLACE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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
BATH TUB
SO. FT. a c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESID g 1 V: c
SEWAGE DISPOSAL
SO.FT.GAR gr 3/� c
HOUSE SEWER
CERT. OCC.
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
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
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 xS
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
l� vvv
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL