002743 (RR)4.4
P.O. BOX 1504 NQ.- 002743
Building 78-105 CALLE ESTADO
Address51-900 AVM Vallejo LA QUINTA, CALIFORNIA 92253
Owner _
{ BUILDING: TYPE CONST. OCC: GRP.-
Mailing,
Address
A.P. Number
City Quirfiz Zip Tel. •
ra 92253 - -_ Legal Description
Contractor Project Description
Address - ..
78-550 D&VbY Zbad
City.. Zip Tela
State Lic.
City
& Classif.. ',"4 921
Lic. # 1.2
Sq. Ft.
Size
No: No. Dw.
Stories Units
Arch.; Engr., _.
Designer
New'_411 Add ❑
Alter ❑ Repair ❑ . _ -Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION...
I 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.
_SIGNATURE /4 - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License law for the following
reason: (Sec. 7031. S,Business and Professions Coder Any .city or county which requires. •a
' permit to construct, alter, 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' pursuantto�:.
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
/or the alleged exemption. Any violation of Section 7031:5 by :any applicant for a. -permit.
' subjects the applicant'Wa civil penalty 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, arid the structure is not intended., or offered for sale. (Sec... 7044, Buisness andr
• Professions -Code: The Contractor's License Law. does not apply to an -owner of property who:COf1St.
Estimated Valuation
1#820.00
PERMIT- -
tV
``• _- AMOUNT
'Plan .Chk.• Dep.
..
Plan Chk. Bal.
- -
•, -�
'' Mech.
-
builds or improves thereon and -who does such work himself -or through his, own employees,
provided that such ,improvements are not intended or offered for sale., I/, '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 /or the purpose o/ sale.)
Electrical
- - -
Plumbing
. .
O 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
does 'not apply to an owner of property who builds or improves thereon, and who contracts for
S. M:I.
_
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
. O I am exempt under Sec. - - B: 8 P.C. for -this reason -
Grading
-
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. ' Company
:O Copy is filed with the city. . ❑ Certified copy is hereby furnished. -
TOTAL'
31,50
CERTIFICATE OF EXEMPTION FROM
'WORKERS' COMPENSATION -INSURANCE
REMARKS
(This section need not be completed if the permit is /or one hundred dollars ($100) valuation
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.
-
-
Date Owner'
NOTICE TO APPLICANT., I/, after making this Certificate of Exemption you should become
' subject to the Workers' Compensation provisions of the Labor Code,' you must forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY:
•Minimum'Setback Distances: '
Front Setback from Center.Line
Rear Setback from.Rear Prop. Line
.. CONSTRUCTION LENDING AGENCY —
hereby affirm that there is a construction lending agency for the performance of.the'
work for which this. permit is issued. (Sec. 3097, Civil Code.)'
Side Street Setback, from Center Line
Side Setback from Property Line.
Lender's Name
FINAL DAT1r2
E �,r� "' INSPECTOR A
- '
ti
Issued by: Date . ermit_ -
Validated by:
Validation:
A 6 8 4 8 12 4 3156 U
Lender's Address
• . This is a building permit when properly filled out, signed and validated; and ismsubject to
expiration it work thereunder is suspended for 180 days.
I certify 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 this city to enter the* 'above-.
mentioned property for in/spectn purposes:,''
Signature of applicant r %' . < s ,/ �•�L..x�� i� �r��Date
' Mailing Address ' V
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
GAS (ROUGH)
DRINKING FOUNTAIN
SO. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ plus x$
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 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
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
ROCKSTORAGE
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL