14839 (SFD)h
P.O. BOX 1504 No. 14839
Building
Address 7B-900 Sunbrook Lane LA QUINTA, CALIFORNIA 92253
"
Owner into Ho.me8
Mailing . '
Address 250 E. Rincon Ste. 202
City Zip Tel.
Corona, CA 91719 (909) 736-0700
Contractor
Sa xie
Address
Tel.:
BUILDING:. TYPE CONST. -- OCC: GRP. Sit
A.P: Numberf
Legal Description Lot 12 Tract 23995--1
Project Description SPE) Plain .2X
Reunion At %a Qui'nta ,
State Lic- City
& Classif. , g 523968 Lic. # 3318 sq- Ft. No.
Size 1565 . - Stories
' Arch.', Engr., ' �.;�.�..
Designer New ❑ Add. ❑ Alter ❑ Repair. ❑
.AGVYSAsast Vje La Guerra (80.5)9f2-4575
City' Zi State ,
.Santa- Barbara, .93101 Lie. # C 12850
1 LICENSED CONTRACTOR'S DECLARATION
1` I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
18000)` f DivI�IoR�o�he Business and Professions Code, and my license is in full force and
No. Dw.
Units
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 thg work for which this permit is issued, I shall not
employany'person in any manner so as to become subject to the. Workers' Compensation
Laws of California
REMARKS
AMOUNT
r5. .50
130. u
138.00
2,177.42-
3,685.-44
,x.77.423, 85.44
Date Owner
'•'SIGNATURE DATE
OWNER -BUILDER DECLARATION'
I hereby affirm that•I am exempt from the Contractor's License Law for the following
reason:. (Sec. 7031.5,Bustness and Professions Code: ,Any -city or county- which requires a
permit to construct, atter, 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
p
ES1lmated ValUatlOn �'96 , . 7•
PERMIT" ..
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 exemption. Any violation of Section 7031.5 by 'any applicant for a permit
-subjects the applicant to a,civil penalty of not more than five hundred dollars ($500).
0. I, as owner of the property, or my,employees with wages as their sole compensation, will
Plan Chk. bep.
Plan Chk. Bal.
Const..
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Code: The Contractor's License Law does not apply to an owner of property who
Mech:
builds or Improves thereon and who does such workhimself or through his own employees, -
provided that such Improvements are not Intended or offered for sale. If,. however, the building
7, or Improvement is soldwithin 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.)
Electrical
Plumbing
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
• struct'the project. (Sec. 7044, Business and Professions Code: The Contractor's. License Law
S.M.1.
does not apply to an, owner of property who builds or improves thereon, and who contracts, for
' •such projects with a ,contractor(s) (i censed-pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. B. 8 P.C..for this reason
Grading
Driveway Enc.
Issued by:, D e•+�i "�efmlt -
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION'
/ o
mentioned property for inspection purposes. _
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker'i ebmpensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code:)'
1
Policy o. Company
_
V;Copy is filed with the city, ❑ Certified copy is hereby furnished.
City, State, Zip
TOTAL
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 thg work for which this permit is issued, I shall not
employany'person in any manner so as to become subject to the. Workers' Compensation
Laws of California
REMARKS
AMOUNT
r5. .50
130. u
138.00
2,177.42-
3,685.-44
,x.77.423, 85.44
Date Owner
NOTICE TO APPLICANT: N, after .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 Re . Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
Side Street Setback Cen Line
SHALL SUBJECT AN EMPLOYER'TO CRIMINAL PENALTIES AND CIVIL'FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, '
Side Setback fro erty
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR'CODE, INTEREST, AND
ATTORNEY'S FEES. `
This is's building permit when filled out, signed is
FINAL DATE SPE��T�R
properly and validated, and 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:, D e•+�i "�efmlt -
I agree to comply with all city and county ordinances and state laws relating to building
�! 7�
construction, and hereby authorize representatives -of this city to enter the above=.
/ o
mentioned property for inspection purposes. _
Validated by: v
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
_
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SO. FT. p
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCKSTORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
ETER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT.
GAS (FINAL)4z S
✓
WALL SO. FT.
-
DRINKING FOUNTAIN.
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
� � /yq�'
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REMARKS:
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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 ® 1Y4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
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 PLU B
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUM
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER O T
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUG )
ETER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)4z S
✓
TEMP. POLE
-
GROUT
WATER HEATS
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING
ROOFING
n
1
� � /yq�'
Ly .�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING -FVJ
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTIONIf I
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL