05227 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 48-543 Via Amistad LA QUINTA, CALIFORNIA 92253
Owner -
Mailing
Address
City Zip Tel.
Northridste 1 91324 818-343-58
Address
clty Zip Tel. Dessert 9225a 345-5430
State Lic- City
&Classif- 195333 Lic.#
Designer
Address Tel.
City I
Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 herebgaffiem that 1 am licensed under Provisions of Chapter 9 (commencing with Section
700gof,lDivision3of the Business and Professions Code, and my license is in full force and
-
effect_ t i +
,�.�-�••� i..B!.IA J.r'+ . / .1'"�.�o .--.�"✓..,•�'..y:°a..;!?:a . ,r dr.�,r�� o h
^•. �Ga➢plftl ro<r-� ..•�. s » .�' v� ✓ tv -� ,/ ✓' -.'.Z DATE
" •-- 4 OWNER -BUILDER DECLARATION I
hereby affipn that 1 am exempt from the Contractor's License Law for the following
reasom (Sec- 7031_5,8usirress and. Professions Code: Any city or county which requires a
paned So construct alter, improve, demolish, or repair any structure, prior to its issuance also
regoacs gh- appricar for such pemdf to file a signed statement that he is licensed pursuant to
Me 9nomWons of Dee Contractor's License Law, Chapter 9 (commencing with Section 7000) of
t hiabn 3 of the EkGkK ss and Professions Code, or that. he Is exempt therefrom, and the basis
Mir the exemption_ Any vkkWbn of Section 7031.5 by 'any applicant for a permit
sur*=ft the appI t fo a ch4 penalty at not more than rive hundred dollars ($500).
® k as canner of the property, or my employees with wages as their sole compensation, will
do the wodr, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Pim Code The Contractor's License Law does not apply to an owner of property who
beftS or impames thereon and who does such work himself or through his own employees,
prodded Bow such improvements are riot intended or offered for sale. If, however, the building
or ftnwerned is sold w0b one year of completion, the owner -builder will have the burden
ofpw*V thN he rid net bald or improve for the purpose of sale.)
LE 1, as owner of the property, am exclusively contracting with licensed contractors to corm
shuct the project- (Sea 7044, Business and Professions Code: The Contractor's License Law
does noh a pfy ED an owner of property who builds or improves thereon, and who contracts for
sticb, 0 2 with a contractors) licensed pursuant to the Contractor's License Law.)
® I am own" under Sea B. & P.C. for this reason
Dide Owner
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent to self -insure, or a certificate of
VVbff 's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Pmd"er•7t NO.Company
(ED Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
fift secftn need not be completed it the permit is for one hundred dollars ($100) valuation
1 ceatify got in the performance of lhp 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
Qate ,Owner
NOTICE 70 APPLICANT_ B, after making this Certificate of Exemption you should become
sm0jetd b the Nkrkers' Compensation provisions of the Labor Code, you must forthwith
comply 00 such provisions or ti's permit shall be deemed revoked.
• CONSTRUCTION LENDING AGENCY
I hereby affn. that there is a construction lending agency for the performance of the
work im which this permit is issued. (Sec. 3097, Civil Code.)
Lenders Name
Lender's Addr�:
This is building p rm when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
certify dal 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
constmtfon4 and hereby authorize representatives ,of this city to enter the above-.
mentioned property for inspection purposes.
Sngrahrre of applicant Date
Maiding Addrnrs
City. Slat Imp
No. 05227
BUILDING: -TYPE CONST. r OCC: GRP.
A.P. Number 517--672-013
Legal Description
ra
Project Description PInn 2H. Lot I3
AMOUNT
Plan Chk. Dep.
$250.00
Plan Chk. Bal.
Sq. Ft. 1950
Size ° °
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition C
36.00
Electrical
79.26
Plumbing
94.00
S.M.I.
7.04
Grading
Driveway Enc.
Estimated Valuation
Linn 439it
PERMIT
AMOUNT
Plan Chk. Dep.
$250.00
Plan Chk. Bal.
113.86
Const.
435.50
Mech.
36.00
Electrical
79.26
Plumbing
94.00
S.M.I.
7.04
Grading
Driveway Enc.
Validation:
Infrastructure
2.270.88
TOTAL
S3,21;7, 14 %P'" � :': —7.
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line,,**,
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date 12/38 Wermit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE 13D i
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCTWORK
ROCKSTORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
DRINKING FOUNTAIN
WALL SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
URINAL
SQ. FT. @
GRADING
cu. yd.
plus x$
=$
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
�l
��i
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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, 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 ® 1% c
SEWAGE DISPOSAL
INSULATION/SOUND ✓/ %
SO.FT.GAR ® 3/•c
HOUSE SEWER
FINISH GRADING
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
D PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 13D i
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCTWORK
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.
FF3XqING 3(?._7 �
FINAL INSP.
FING
l
�l
��i
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
�y
LATHING
MESH
INSULATION/SOUND ✓/ %
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
\