05420 (SFD)TAiyl 4-
P.O. BOX 1504 N O . 05 420'
Building 78-105 CALLE ESTADO
Address 54-533 SOUTH MLS;.,.; QUINTA, CALIFORNIA 92253
Owner, =ME COMM
r.=
Mailing rY j BUILDING: TYPE CONST: OCC: GRP.
Address 4.2-600 GOOD STR insA:P. %. Numbe>.,
...,.�..� r•...,, ...
City Zip Tel.
PATO-DIS .92260 568_2��q, Legal Description In G!' A
Contractor Project Description PHI= 1H SM y
,.
NAT IONAT, MORTGAGE
Address .. .
• Ste . -
City Zip Tel.: •-
State Lic. City
2$8}30 20$ Sq. Ft. No. No. Dvli:
& Classif:.. Lic. #
Arch_, Engr:,
Size 340 1.
Stories - Units-
Designer New ❑ Add ❑ Alter ❑: Repair' ❑ Demolition ❑
Address-, Tel.
City Zip State '
Lic. #
LICEDISED CONTRACTOR'S DECLARATION
I hereby affirm that lyam licensed under provisions of Chapter 9 (commencing with Section
7(100) of Division 3 of the Business and Professions Code, and my license is in full farce and 1
r effect.
SIGNATURE r DATE - -
OWNER-BUILDERDECLARATION" E t t d V I t'
I hereby affirm that 1 am exempt from the Contractors License Law for the following
reason: (Sec.- 7031.5,Buskiess and Professions Code: Any city or county which requires a
Permit . to constrtict, alter, improve, demolish, or repair any structure, prior. to its issuance also
requires the applicant for such permit to file a signed statemenrthat he is licensed pursuant to
the provisions of the Contractors 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 penafty of not more than five 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 Contractors License Law does not apply to an owner of property who
builds or inproves 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
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.) -
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
s Uma e a ua Ion 242,430
S.M.1.
PERMIT.
AMOUNT
Plan Chk. Dep.
r
Plan Chk. Bal.
•
Const.
1,14u: t7
Mech.
•
•Electrical
-.Plumbing
INnAMUR
struct the protect (Sec. 7044, Business and Professions Code: The Contractors License Law
does not appy to an owner or property who builds or improves thereon, and who contracts for
S.M.1.
• '
such projects with a contractors) licensed pursuant to the Contractor's License Law.) • - - • • -
❑ I am exempt under Sem a, 8 P.C. for this reason
Grading
'
Driveway Enc.
Date Owner
Infrastructure
a' ,5 • 8
• WORKERS' COMPENSATION DECLARATION
INnAMUR
hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers 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.
__
=L.____
TOTALy'j�
REMARKS
`
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit.is for one hundred dollars (S100)valuationMy"
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
y�y
1Ki7giS�1 �•t�-c�i•. I��i'"�.1�Ce- � �a ,?�3, .a�;•'ryh •f•'i�
..
Date Owner '
NOTICE TO APPLICANT: ff,' after makig this Certificate of Exemption you should become
' subject to the 'workers' Compensation provisions of the Labor Code, you must forthwith
,Comply with such Provsiorrsor Udspemmitshallbe deemed revoked. -
ZONE: - BY: ' " • �'
Minimum Setback Distances: ..
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
1hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil coda.)
Side Street Setback from Center Line
Side Setback from Property Line
Lenders Name
FINAL DATE-
INSPECTOR
3/3/89,
Lenders Address
' 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 1 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 this city toenter. the -..above..
mentioned property for inspection purposes
- -. — ;Y -
Issued by:
Validated. by:
Date Permit j
4
_
Signature of applicant " Date
r
• Mailing Address'
Validation:
+
City,. State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SO. FT. ® $
UNITS
S GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS
ER OR SEPTric tAM 9Z5
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO F7 ®
GAS (ROUGH) / . z
O�
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CARP. SO. FT. ®
I
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN.
BOND BEAM
WATER SYSTEM
URINAL
SO FT ®
=$
LUMBER GFL
ESTIMATED CONSTRUCTION VALUATION $
ING 1
WATER PIPING
NOTE Not to be used as property tax valuation
D� t'i�i�u� t'3
/
FLOOR DRAIN
MECHANICAL FEES
REMARKS:
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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. ®c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
FINAL INSPECTION
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 BACK
UND PLUMBING01
UNDERGROUND
A.C. UNIT
COLL. AREA
S GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER OR SEPTric tAM 9Z5
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) / . z
O�
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 GFL
FINAL INSPC-;?,a 0
ING 1
FINAL INSP.
OOFING C� Cv/1 %'
i
D� t'i�i�u� t'3
/
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING,
FIREPLACE
SP K ARRESTOR
A ALL 1
LATHING
M
SULATIONISOUND �l
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINTTIALS
GARDEN WALL FINAL