06987 (BLCK)M
a/8 P.O. BOX 1504 N Q . 06987,
.
Building 78-105 CALLE ESTADO
Address .Lq,QUINTA,-CA_,LIFORNIA 92253
Owner µ w
Ventura Jimenez _ t
Mailing «� BUILDING: TYPE CONST. OCC: GRP: '
Address V 0. BOX 1.55 A.P. Number 773—Z-13-024.
City Zip Tel. ' "
La . Ufa .92853 564-2072'Legal Description
Contractor Project Description : 'til X I5f1a. F,rat^raiar{rso ' l
•..�
Address.
City Zip Tel.:
State Lic. City
& Classif: Lic. # Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
g-; -Address Tel.
City Zip State
• Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affimm 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 DATE _ !
OWNEWBUILDER DECLARATION' • Estimated Valuation
•1 hereby affirm that 1 am exempt from'the Contractor's License Law for the following'r
,reason: (Sec. 7031.5,Busness and Professions Code: Any city or county which requires a o-
P
ermit to censtnrU, , aAer, improve, demolish,. or repair any structure, prior to its issuance • also - i
requires ftie applicant for such permit to tWa signed statement that he is licensed pursuant to PERMIT - AMOUNT
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 o/ Section 7031.5 by any applicant for a permit Plan -Chk. Dep.
subjects the applicant to a civil penally of not more than rive hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work; and the structure is not intended or offered for. sale. (Sec. 7044, Buisness and
Professions
. c
Professions. Code: The Contractors. License Law does not apply to an owner of property who • Const. $54.00
builds or improves: thereon and who does such work himself or through his own employees;r -
provided that such irprovemermts are not intended or offered for sale. If, however, the building Mech.
orImprovement is sold wiltdo 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 com. Plumbing
Strutt 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.1. i,2 r
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 L
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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
O Copy is filed with the city. , ❑ Certified copy is hereby furnished. / ? %
• TOTAL -.,.� �- - .�"'
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE •
(this section need not be completed it the permit is for one hundred dollars ($100) valuation 3
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
• employ any person in arty manner so'as to become subject to the Workers' Compensation -
Laws of Califomia
Date Owner'
NOTICE TO APPLICANT: ll, 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 shalt be deemed revoked.
Minimum Setback Distances: '
Front Setback from Center Line
Rear Setback from Rear Prop. Line
r CONSTRUCTION LENDING AGENCY
Side Street Setback from Center. Line
I hereby affirm that there is a constructionlending 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
2/6/90
This is a building permit when property filled out; signed and validated, and is subject 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
Issued, by
Date Permit
agree to comply with all.city and county ordinances and state laws relating to building
construction, and hereby authorae representatives •of this -city to; enter' the -above-.
,mentioned property for inspection purposes- • _• i1
Validated by:
.Signature of applicant Date
Mailing Address
Validation:
' City_ State, Zip
, _
;
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN,
WALL SQ. FT.
=$
LUMBER GR.
FINAL INSP.
URINAL
SO. FT.
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIREPLACE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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 ® 1Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Lc
HOUSE SEWER
CERT. OCC.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE IPL.CK.FEE
CONST. FEE JELECT.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 APPJEQUIP.
REIN F. 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 SIGNATURESJNITIALS
GARDEN WALL FINAL