003896 (PAT)�tif 4 4QUbrw
P.O. BOX 1504
Building78-105 CALLE ESTADO
Address 7-9"305 IT. sunset Ridge SLA QUINTA, CALIFORNIA,92253 „ , 4 ...
Owner Y
rld Donaitele
Mailing
Address Dewe Cir�. Xlvo Mr.
City Zip
' Palm ; �,Sert 32260.-. -
.Contractor
..mer/Builder..
.Address
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number La O1 t3. Palmi „
IT—ela
3"¢°� Legal Description
..Patin Cover
Project Description
Cit y * .
Zip
Tel:
State Lic.
City
& Classif.
Lic. #
Sq. Ft.-
No. No. Dw.
Size
Stories Units
.: Arch.' Engr.; _.
Designer
New ❑ - Add -0 M Alter ❑'' Repair. ❑' Demolition ❑
Address
Tel.
City
Zip
State
-
Lic. # -
LICENSED CONTRACTOR'S DECLARATION
hereby affirm that] am licensed under provisions of Chapter (commencing with'Section
7000) of Division 3 of the Business and Professions Code, and my -license is in full force and' '
"
effect. .
SIGNATURE DATE
" OWNER -BUILDER DECLARATION
'1
Estimated Valuation
' 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
'permit td construct, alter, improve, demolish, or repair any structure, prior to its issuance also
-
'
requires the applicant such permit to file a signed statement that -he isdicensed pursuant to
.. PERMIT' • .
- - - AMOUNT
A
the provisions of4he 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 exemption. Any Section 7031.5..by 'any for
Plan Chk. Dep.
-
violation of applicant a permit
- 'subjects the applicant to a civil penalty of not more than`Iive hundred dollars ($500). -
Plan; Chk. Bal..
_ -
. 0 1, as owner -of the, property, or my employees with wages as their sole compensation, will
...
,.
do-the.woik, and the structure is not intended or offered for sale. (Sec. 7044; Buisness and
COnSt.
S2i�
Professions Code: The Contractor's License Law does not apply,to an. owner of property. who
. 0I0 .
._
• builds or improves thereon and who does such work himself or through his own employees,
'MeCh.
. provided that' such improvements are, not intended or offered for sale. If, however, *the building
- .
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 I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
• struct the project. (Sec. 7044, Business and Professions. Code:, The Contractor's 4 License Law -
does not apply to an owner of property who builds or improves thereon, and who 'contracts for
S. M.
.-
- such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
f B.
Grading
❑ 1 am exempt under Sec. & P.C. for this reason
Driveway Enc.
Date Wl-- ./f "owner �) s•A �- r�* -
Infrastructure
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have'a certificate of consent to'self- insure, -ora certificate of '
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)•
Policy No.' Company
p Copy, is filed.with the city... ❑ Certified, copy is hereby furnished. .
TOTAL
_
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed if the permit is for one hundred dollars ($100) valuation' -
- �..'�7i�4'f
- - or less.) . ... .. _ .... _ . ..
..
. I certify that in the performance of tha work for which this permit is issued, I shall not
employ any person in any mannerso'as to become subject to the Workers' Compensation -
Laws of California.
" Date Owner
NOTICE TO APPLICANT: If, afar making this Certificate- of Exemption you should become
'the
ZONE:'
BY:
subject' to 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
hereby affirm that there is'a construction lending agency for the performance of the
•from
work for which.this permit is issued.. (Sec..3097, civil code.) -
Side'Setback Property Line
Lender's Name
. Lender's 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 certify that I have read this application and state that the above information.is,correct.
'Issued by:
/
Date Permit >
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
Mailing Address
Validation:
' City,.State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SOFT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
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. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
HOUSE SEWER
REMARKS:
VENTILATION
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 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
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
'FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL