10025 (RPL)4
.� P.O. BOX 1504 No. 10025
Building.78-105 CALLE ESTADO
Address 53-845 Vallejo LA QUINTA, CALIFORNIA 92253
Owner
DaVi d Fisher BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address 53650 Diaz
A.P. Number
City Zip Tel.
La Q xrz 92253 564--2539 Legal Description Lot 7 9 So. OIL:lot 6
Contractor Project Description POOL ONLY
David Fisher
Address
c ,.np.
City Zip Tel.:
State Lic. City
& Classif. B1 334932 Lic. # 1809 Sq. Ft. No. No. Dw.
Size Stories . Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address`' Tel.
City Zip State
f Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licepsed under provisions of Chapter 9 (commencing with Section
P
(7.f0f06) of Division 3 of the BuslnessaKd =professions Code, and my license is in full force and
SIGNATURE °' DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following 81000
reason: (Sec. 7031.5,Business and Professions Code: 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 lila 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 basis . plan Chk. De
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit p
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). o
Plan Chk. Bal.
O I, as owner of the property,,or.my employees with wages as their sole compensation, will
% do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. y • V
Professions Code:The Contractor's License Law does not apply to an owner of property who
build§. or Improves thereon and who does such work himseg or through his own employees, Mech. Z$• UU
Provided that such improvements are not intended or offered for sale. N however, the building .
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical 3u • 00
of proving that he did not build or improve for the purpose of sale.)
b.I, as owner of the property, am exclusively contracting with licensed contractors to con- . Plumbing 24 • 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.I. • UU,
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 1 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
Cj Copy is filed with the city.: ❑ Certified copy is.hereby furnished.
TOTAL d
CERTIFICATE OF EXEMPTION FROM REMARKS.
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100). valuation rt`st's�' �."i �,`.,, f ()Utz ol— J t;� 4R,a, ., , ,. ], i.
or less.) 4 V f, e!oa x r 4 tar 9 r••x:, A 41 V i, + -r
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 Certifcr to of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.Minimum
Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I 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 Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
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 county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above-.
mentioned property for inspection purposes- Validated by:
Signature of applicant Date'
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
A.C. UNIT
2ND FL SO. FT. ®
SLAB GRADE
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOMESVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. S0. FT.
ROUGH WIRING.
DRAINAGE PIPING
WALL SO. Fi.
DUCT WORK
DRINKING FOUNTAIN.
SO FT ®
GAS (ROUGH)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
REINF. STEEL
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SERVICE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
WATER SYSTEM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEWPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
j^/2/y/
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® t1/s c
SEWAGE DISPOSAL
SO.FT.GAR ® Vic
HOUSE SEWER
FIRE ZONE ROOFING:
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 APPJEOUIP.
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
/�%�
j^/2/y/
A --
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