001666 (BLCK)Building
Address
Owner
mailing
Address
City
Contractor
P.O. BOX 1504 No. 001666
.51—M Aveni& VeMsm LA QUINTACCALIFORNIA 92253
pdck JokmlA==tdM,- . BUILDING: TYPE;CONST. OCC: GRP.
P.Q. B= 2223 A.P. Number
Zip Tel.
9220-1 564-2228 Legal Description
di Jr�. 2 C��� Project Description
...Address _
City Zip
sow
State Lic.
& Classif.
Arch., Engr.,
Tel:
City
Lic. #. Sq. Ft. No. No: Dw.
Size • 230 Stories Units -
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
"
City
Zip
State
Lic:#...
• LICENSED CONTRACTOR'S, DECLARATION .
I hereby affirm that L,am•licensed under provisions -of Chapter 9 (commencing with Section
7000) of Division`of�'the Business and Profsessions; Code, and my license'is in full force and'
effect.,,ir_`.."""
SIGNATURE �- i' DATE
OWNER -BUILDER DECLARATION
EStllrtated Valuation
I hereby affirm that I am exempt from the Contractor's License Law .for the following 'pid�riV�i
'a'
reason: (Sec. 7031.5,Business-and Professions Code: Any city or county which requires ,
permit to.:construct, alter, improve, demolish, or repair any structure, pnor.to its issuance•also
requires the. applicant for such permit to rile a.signed statement that he is licensed pursuanttoPERMIT
- -AMOUNT
the provisions of the Contractor's License Law; Chapter 9 (commencing with Section 7000) of
-
' vision 3 of the Business and.Professions Code, or. that. he' is exempt *therefrom, and the basis
for the Any Section 7031.5 by 'any for
- -
• Plan. Chk. Dep.
-
alleged exemption. violation of applicant -a permit
subjects the applicant to a'civil'penalty of not more than five hundred dollars ($500). .: — '
Plan Chk. Bal. �
AA!4 eq2
❑ 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
*not
COf1St.
��
d� rL
44+
Professions Code: The Contractor's License Law does. apply to. an owner of property. who.
builds or improves thereon and who does suchwork- himself or through his own employees,
' MBCh.
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:) , .
❑ 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 License Law
-
does not apply to an owner of property who builds or improves thereon, and who contracts for
S.M.I.
- a 50
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
. O I am exempt under Sec. B. & P.C: for thisreason
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
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. ' 1 Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished '
TOTAL
73.92
CERTIFICATE OF EXEMPTION FROM
REMARKS
_i 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
employ any person in any manner so as to become'subject to the,Workers' Compensation
Laws of California.
-
- - -
' Date ' Owner'
NOTICE TO APPLICANT: If, 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.Rear. Prop. Line
CONSTRUCTION LENDING AGENCY
'is
Side Street Setback, from Center Line
I hereby affirm that therea construction, lending agency for the, performance of the
work for which this permit is issued_ . (Sec. 3097, Civii.Code.)
Side Setback from Property Line
Lender's Name
T
FINAL DATE ' INSPECTOR /
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 I have read this application and state that the above information is correct. -
'
.Issued by:
Date Permit..
I agree to comply with all city and countybrdinances and state laws relating to building
construction, and hereby authorize representatives !of . this-tcity to- enter the above-.
-
..
mentioned property for inspection purposes. j; - _
`'1 s �"
Validated by:
Signature of applicant«w '` / s^ : /' S '�•'� Date r r�
Mailing Address %'
Validation:
City, State, Zip
A2257
8 9 7392 J.1
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL.SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CARP. SQ. FT.
WALL SQ. FT. ®
SQ FT ®
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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
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 APP./EQUIP.
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
l