001585 (RPL)• Iry
P.O. BOX 1504 N .: 015851
Building, 78-105 CALLE ESTADO
Address 44-266 E%7eg't Sof: CreSt Dr_A QUINTA, CALIFORNIA 92253
Owner
.. .
BUILDING: -TYPE CONST. OCC: GRP.
Mailing
Address lonrdamst. • 2700 _ A,P.,Number. -
City Zip Tel.
- --- - Le al Descri tion
Contractor
.Address
ity' -
_;Ta t ,
67-°7U Pwm Mad
Zip . _. .
Project Description 30 x 17, Pool '
State Lic.
& Classif..
City
Lic. #
Sq.'Ft.' •
Size . ..
No. No..Dw.
Sto ries Units. .
Arch:, Engr....
DesignerNew:l
...Address
Add ❑
Alter ❑ Repair ❑ Demolition❑ ..
Tel.
or less:) ... -
I certify that in the performance of the work for which this permit is issued, I shall not'.
City
Zip
State
Lic. #
' LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I em 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. y Y ,, ✓
•• "r'
Date . -Owner .. .
SIGNATURE - _ DATE
OWNEWBUILDER DECLARATION •
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:'
. permii 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_ pursuant to
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, :'a-nd the basis
for the alleged exemption. Any violation.. of Section 7031.5. by.. 'any applicant, fora .permit
subjects the applicant'to a'civil penalty of not more than five hundred dollars ($500).
O I, as owner of the ro erl ,•or m employees with.wa es as their sole compensation, will
p p y y 9 p
do the work, and the structure is not intended or offered for sale. (Sec. 1044, Buisness and
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,
.. 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 -
of proving that he did not build or improvefor the purpose of sale.)
I, as owner of the property, am exclusively 'contracling with licensed contractors to con-
strucl the project. (Sec. 7044, Business.and Profession's Code: The Contractor's License Law
•, does not apply to an owner of property who builds -or improves, thereon; and who contracts for
- such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
0 I.am exempt under Sec. B. & P.C.-for this reason
Estimated: Valuation
-'
I S.-
PERMIT . •
- ' '
-
'. - AMOUNT
Plan-Chk. D'p.
..
Plan Chk:. Bal.
COr1St....
Front.Setback.from.Center Line
•
Mech.
.
Electrical
17info
Plumbing
i -
' S•M.I.• -
_ .
- -w-
Grading
work for which this permit is issued. (Sec: 3097, Civil Code.)
Driveway Enc.
Side Setback from Property Line
Date owner
Infrastructure
Lender's Address
FINAL DATE'
WORKERS' COMPENSATION DECLARATION
Ihereby'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
.. ❑ Copy is filed with the city. ..0 Certified copy is hereby furnished.
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:
TOTAL
-
CERTIFICATE OF EXEMPTION FROM " '
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed, if the permit is for 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: 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
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 forAnspection purposes. .
Validated by:
Signature'of applicant Date
Mailing Address
Validation:
City, State, Zip
A1728
6 25 12684 R
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SO. FT. ®'
POR. SO. FT. ®
GAR. SQ. FT.
CAR P. SQ. FT.
WALL SQ. FT.
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $.
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
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 p 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
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 FANK
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
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