001588 (RPL)P.O. BOX 1504 N O. 001588
Building 78-105 CALLE ESTADO
Address 44-420 RMt SUndMqpCfeSt ML.QUINTA, CALIFORNIA 92253
,• Owner
Mailing
BUIL'DING:' TYPE CONST. OCC: GRP.
Address 3.001 A"him Ste Slice 2700 ..
A,P, Number
City Zip Tel.
• %7_5054
Legal Description
'30
Project Description
'
x'172o6l.
Contractor
Wifamids 1 S arA .Sas
Address. . ,.
67-M ram Fbad
City
CaLtb C t
Zip. _ ... •:..
92234
Tel.'
3�377343
State Lic.
City
& Class:if.. 18-5142
Lic. #
Sq. Ft
No. No. Dw.
Size • '
Stories - ..Units
--Arch., Engr:, '
Designer
New 9 Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
.•
Lic: # ...
• LICENSED CONTRACTOR'S DECLARATION ... ..
I hereby affirm that I am -licensed under provisions of Chaptei 9 (commencing with Section
7000)of Division Q
3 of Business .and Professions Code, and my license is in full force and -
effeA (4
-
' SIGNATURE 1' ' DATE•
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. , •'
permit to construct, atter, 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 o/ 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 •-
• /or the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
,. ❑ I- as owner• of the property, or my employees with as their sole compensation, will
do ilia work, and the structure is not intended or offered for sale. (Sec. 7044, 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 orr.fhrough his own employees,
provided. that such improvements are not intended or offered /or sale. I/, however, the. building
or improvement is sold within one year of completion, the owner -builder will .have the burden
of proving that he,did.notbuild or improve. for the purpose o/ sale.) -
Estimated Valuation
1� A
• - '
••
PERMIT -
- - - • '
- - AMOUNT' -
Plan Chk. Dep.'
_ - - -
.
Plan ChkBBI.
.7 >•-37/L
Cof1St.
y7�
- ' blV.50
-Meeh:.
EleCtrIC81.
,
" 12'*- (]�
0
Plumbing
-14.00
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con.
slruct the project. (Sec. 7044, Business and Professions Code: The Contractor's -License'-Law
does not apply to an owner o/ property who builds or:improves thereon, and who contracts for
•such,projecfs with a confractor(s) licensed pursuant to the Contractor's License Law.) -
...,p.l am exempt under Sec.. B.-&•P.C. for this reason
S.M,I.
1.02•
Grading
.•
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
❑ Copy is filed with the city. , ❑ Certified copy is hereby furnished. '
TOTAL •
226.14
REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it 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, 1•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: • I!,after making this Certificate of Exemption you should become
' subject to the Workers' Compensation provisions o/ the Labor Code, you must lonnwirn
comply with such provisions or this permit shall be deemed revoked.
ZONE: - BY: '
.Minimum Setback Distances: - - '
Front Setback from Center Line
Rear Setback from Rear Prop..Line
CONSTRUCTION LENDING AGENCY.,
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 Street Setback from. Center Line
Side Setback from Property Line `
Lender's 'Name
Lender's Address
FINAL DATE
Issued by:
.
Validated by:
Validation:
A 1 7 2 5
INSPECTOR -
INSPECTOR
Date S"25 "85 Permit
- -
6 L.S. ... 226.84• CK
• 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..
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. j
Signature of applicant 1� Art f - E +'• Date
Mailing Address °
.City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. @
CAR P. SO. FT.
WALL SO. FT. p
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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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
ROCKSTORAGE
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 SIGNATUREEIINITIALS
GARDEN WALL FINAL
4 .,