06007 (SFD)Building
Address. 54—ms Sr':
Sunrise Co.
Mailing I
Address .'75-005 5,05 Co1i31C8'y Clu i,
City Zip
922,60
Contractor
" same
• Address, .
City .. ,
State Lic.
& Classif.-_::: 2$6'13E1
Aitch., Engr.,'
Designer,
,S Address' �:�• '
P.O. BOX 1504 N o .
78-105 CALLE ESTADO.,. -
fZ LA'QUINTA, CALIFORNIA 92253 u '
BUILDING: -TYPE CONST: ' -OCC. GRP.
A:P. Number - _ PGA W@st x
Tel.
6-2BZ; Legal Description a
Project Description tease •199 Plias 40?
_ t
fifty
Lic. # 323. ., Sq. Ft No.
Size '�i�2 Stories
Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 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 -„.r.+- r
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law forthefollowing
reason: (Sec. 7031.5,8usiness and Professions Code: Any city or county which requires a
No. Dw.
Units .t
l New CZ Add p Alter O Repair I] *`' • Demolition O
on ' 215,834.fl-0 tr `
>
permit -to construct, alter, Improve, demolish, or repair any structure, prior to its issuance also
requires the applicant,lor such permit to file a signed statement that he is licensed pursuant to
PERMIT
-
4” - 'AMOUNT •'
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section* 7000) of
-
4 •+-
- Division 3 of the Business and Professions Cade,. 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
Plan Chk. •Dep.
t r subjects the applicant to a civilpenalty of not more than rive hundred dollars.($500).
Plan Chk. Bal. •,
$ rag ;'�,
• ❑ 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,
'Professions
Const.
a
��•;
Code: The Contractor's License Law does not 'apply to an owner ofpropertywho
I '. builds or improves thereon and, who does such work himself orthrough his own employees,
'
Mech. -
£2.50 '
provided that such boprovements 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 -
- 153,047 ` •'
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
2 MIN .
e
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.) -
Grading
❑ 1 am exempt under Sec B. & P.C. for this reason
'
Driveway Enc..
„ Date Owner =
Infrastructure
48562.26 j
� 5
I 2428.13 r • y.n .. .. y
f
WORKERS' COMPENSATION DECLARATION
Intra lyulu
I hereby affirm that'l 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
I'.. ❑.Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCEA.i
REMARKSitYi
(This section need not be completed if the permit is for one hundred dollars (8100) valuation
-
or less.)
I certify that in the performance of thg 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–LL—owner
NOTICE TO APPLICANT,B, after making this' Certificate or 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,
, 77-
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!here 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
- Lenders 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 for 180 days.
6-19-89
suspended
I certify that I have read this that
1 j
/ '
application and state the above information.is,correct.
I agree
- Issued by:
Date Permit •'
to comply with all city and county ordinances and state laws relatingto building
construction, and hereby authorize representatives -of this city to 'enter the above•.
f mentioned_ property for inspection purposes.
Validated by:
Signature of applicant y Date
'3
Mailing Address
Validation:
City, , State,- Zip
i . a CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
B GRADE
GH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT.
FOR
gROUND
ER OR SEPTIC I
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
UGH) ! 2
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CARP. SQ. Ff. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN,
WALL SQ. FT.
=$
LU BER GR.
FINAL INSP.
ING /b--/"'
URINAL
SQ. FT.
t�k wl�a.
to
ESTIMATED CONSTRUCTION VALUATION $
REMARKS:
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SPARK ARRESTOR
LAUNDRYTRAY
AIR HANDLING UNIT CFM
G .FIREWALL/
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.
SQ. FT. ® c
BATH TUB
FINISH GRADING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1I/• c
SEWAGE DISPOSAL
SQ.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
S ACK
PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE
GH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FOR
gROUND
ER OR SEPTIC I
ROUGH WIRING
DUCTWORK
ROCKSTORAGE
D. REINF.
UGH) ! 2
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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.
ING /b--/"'
INAL INSP. �\
00FING /O
t�k wl�a.
to
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
G .FIREWALL/
HI G l( Z
MES
LATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL
1