12251 (PLBG)_,Q
T4 41.16a "
1
s' P.O. BOX 1504 N0. 1,44 z' e
78-105 CALLE ESTADO
Address 52- 540 Vallejo LA QUINTA, CALIFORNIA 92253 e
Owner
Mr. Mrs. Juvenal Barajalis, Mailing BUILDING: TYPE CONST. C: f OCGRP.
„ '
Address Sams-'
A.P. Number
City
X.a Quint,j, C [Zip Tel. 32253 Legal Description
Contractor �.. . . Project Description Sewer Connect
nendrio2cson Cons otaons enc;
68-315 Kieley Road
ci%athedrai. Cit��p 92234
State Lic. ki �$fii84 `L
& Classif. ,
Arch., Engr.,
Designer
Address
Tela
326-1747
City 1.94
Lic. #
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 Busines •andrProfessions Code, and my license is in full force and
effect.>I,-,"f_- �_i > C
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
Sq. Ft. No. N'o. Dw.
Size • Stories Units _
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $2P214.00
permit to construct, alter, improve, demolish, or repair any structure, 1 prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
PERMIT
AMOUNT
• 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 ba s
plan
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
Chk. Dep.
subjects the•applicant to a civil penalty of not more than five hundred dollars (8500).
Plan Chk. Bal.
❑ 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
Const.
Professions Code: The Contractor's License Law does not apply to an owner of property who
-
builds or improves thereon and who does such work himself or through his own employees,
Mech.
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.)
f ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
34.00
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. 1.
'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
.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. 0 Certified copy is hereby furnished.
TOTAL
34.40
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hundred dollars (8100) 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: 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
Side Street Setback from Center Line
Ihereby affirm that there is a construction lending agency for the performance of the
6 ----work for which this permit is issued. (Sec. 3097, Civil Code.)
Side Setback from' Property Line
Lender's Name
t _.
Lender's Address
FINAL DATE
INSP OR
ZA
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. '
Ll
I certify that I have read this application and state that the above information is correct.
Issued by:
Date
P rmlt
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 for inspection
�
P
RFP
property purposes.
:i
Validated by:
Signature of applicantDate
'R
- Mailing Address
Validation:
City, State, Zip
i
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
SEWER.QR-8ePT10-4~
3ROUGH WIRING
MOBILEHOME SVC. -
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET.
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
'
DRAINAGE PIPING
CAR P. SO. FT.
FINAL INSP.
WALL SO. FT.
WATER SYSTEM
DRINKING FOUNTAIN,
GRADING
cu. yd.
$ plus x$
=$
URINAL
SO. FT. ®
FINAL INSP.
FRAMING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOSE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMITSVC
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 ® 1+/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSPECTION�f) 3 L%)
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
rv1ECH.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.QR-8ePT10-4~
3ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
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�f) 3 L%)
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS '
GARDEN WALL FINAL