05990 (SFD)Building
Address 54-747 Southera Hills
Owner
-surwis 'Co.
Mailing
Address • .75-005 Country Cls
City Zip
. P. D., 9226 0
Contractor sarad
e P.O. BOX 1504 N o .
7&105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING:. TYPE CONST: OCC: GRP: • f
�3 A.P. Number PQ kgg. i >
Tel.z.
fib$-2i2f3 Legal Description
Project Description Fhayla 19B PI 16y
State Lic. City
&:Classif.- 288130 Lic.#
a•a..Arch., Engr,.,, =:
Designer,'
Address - ' Tel.
Sq.. Ft. $Za2 ; No.
Size zg Stories
New L'I Add ❑ Alter ❑
No. Dw.
Units] -
Repair ❑ 'Demolition ❑
j
City
Zip
State
Lic. #
7 -
•`
- i - LICENSED CONTRACTOR'S DECLARATION'
I hereby affirm that'l 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. o- . � - ,r
- SIGNATURE - DATE
• OWNER -BUILDER from
theCo DECLARATION •'
' 1 hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
y gli� ; . t '
158,646.00
i
reason: (Sec. 7031.5,Business and.Professions Code: Any city.or county which requires a
�'
PERMIT
-
j AMOUNT
permit to constrict, alter. Improve, demolish, or repair any structure, prior to its issuance also
requires the -applicant for such permit to rde a signed statement that he is licensed pursuant to
the provisions of,the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
.' Dm'sion 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
Plan Chk. Dep4'
, subjects the applicant to a civilpenalty of not more than two hundred dollars ($500).
❑ 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 Code: The. Contractor's License Law does not apply to an owner of property who
Plan Chk. Boll.
-
Const.
• -
Mech. .. •�
a2 •,+u
'
builds or knproves 'thereon and who does such work himself or through his own employees,
provided that' such Improvements are not intended or offered for safe. If, however, the building
Electrical
_
` t ,'`+. at: .
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.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
192.09
^ struct the project (Sec. .7044, Business and Professions Code:.The Contractor's License Law
does not apply to an owner of.properly who builds.or improves thereon, and who contracts for
'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
S.M.I.
i • - r
Grading
Driveway Enc.
+
Dateowner
Infrastructure
�•
' WORKERS' COMPENSATION DECLARATION
Intra Due
•' d.
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
❑ Copy is filed with the city. . ❑ Certified.copy is hereby furnished.
..
-
TOTAL
`b ,,tri ''.�} :!� �:�",'�'.�" •
' 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.)
1 certify that in the performance of thg work for which this permit is issued, l shall not
employ any pperson in any manner so as to become subject to the Workers' Compensation
Laws of Calmf0 nia
REMARKS
h •. :"d,, "x:i< "^r rr>e =:i _ is'..rOX
_
,
r - r• ,
Date ' Owner
- N077CE TO APPLICANT: !f, 'after making this Certificate of Exemption you should become•
SWect to the 'Workers' - Compensation provisions of the Labor Code, you must forthwith
Comply With such Provisions orthis Permit shall be deemed revoked. `
ZONE: BY: - '-
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. LineO
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097. CivitCode.) ;
Side Street Setback from Center Line—
Side Setback from Property Line l_
Lender's Name
Lenders Address
FINAL DATE
ISSUed by:
Validated by:
'
INSPECTOR
f.
Date Permit
+
''
' 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 certity 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 thin city to • enter the -above-:.
mentioned property for inspection purposes. -
'Signature of applicant Date'
F
(
Mailing.Address
Validation:
..
—
City,. State, ZIP
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
R?PQH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMSSEWER
OR SEPTI A
ROUGH WIRING,
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
AS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CARP. SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL S0. FT.
=$
LUMBER GR.
&INAL INSP.
a�
FRAMING
URINAL
SO. FT.
/
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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SPARK ARRESTOR
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAR. 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.
SO. FT. ® c
BATH TUB
FINISH GRADING
SO. FT. ®c
I WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR (off V4c
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
XTOLUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
R?PQH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMSSEWER
OR SEPTI A
ROUGH WIRING,
DUCT WORK
ROCK STORAGE
ND. REINF.
AS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJE0U1P.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ plus x$
=$
LUMBER GR.
&INAL INSP.
a�
FRAMING
FINAL INSP.
OOFING
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
T ING 1 Q 4
MESH
SULATIONISOUND (Q Z
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
,