003586 (BLCK)P.O. BOX 1504 No. 003586
Building 78-105 CALLE ESTADO
Address 44-440 E. :'E38ldC#wn Crest Lt•A QUINTA, CALIFORNIA 92253
Owner
Mr. MnRbp-r
Mailing. G: BUILDINTYPE CONST. OCC: GRP.
Address
Same A.P. Number
City Zip Tel.
xa:._on-In ..-.92253 �. Legal Description
Contractor Project Description
_ i1,4;e O a A a a^e.! i
Address
CitV _.. ZiD
State Lic.
City
& Classif.
Lic. #
Sq. Ft.
No. No. Dw.
Size
Stories Units
• Arch., `Engr., ......... .... _.
' .'Designer.
New ❑ Add ❑
Alter ❑, Repair ❑ .. Demolition ❑
Address
Tel. '
City
p
State
_...
'77
.Lic.
# . .
—LICENSED CONTRACTOR'S DECLARATION
I herebyy; affirm that I am,,licensed under provisions of Chapter9 (commencing Section
"�•
.•r. with
• %0) of•Division 3 of tWlilustiness and'Professsions Code, and my license is in full force and
-
.
effect. _ +• �,- J `Jf f-e/m >'"�r+A ' f
''
..
SIGNATURE �..... �.-- i,,... _. DATE
...
.. ..
' OWNER.BUILDER DECLARATION
Estimated Valuation
hereby affirm that I am exempt from the Contractor's License Law for the following
,
.$400 A0 '
.reason: (Sec. 7031.5,Business and Professions Code: Any city, or. county, which. requires a
'
--
'
permit to construct,';a/ter, tmprove,*demolish, or repair any structure, prior to its issuance also•.
- s,-
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 that7he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicanh.�Ior a.permit
Plan Chk. Dep.
- ••• -
' subjects the.applicant to a civflpenalty ofnot more than five hundred dollars (5500). ' ' `
Chk. Bal.'
1......0 I, as owner of the property, or my employees with wages as their' sole' compensation, will
..Plan
do the work,.arid the structure isnot intended or offered for sale. (Sec.'7044, Buisness and
Const..
Professions Code: The-Contractors.License Law does not apply%to anowner ofproperty, 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. (f," however, the building
:or improvement is sold within one year of completion, the owner -builder will.have-4he burden
Electrical
'
of proving that.he did not build or improve for the purpose of sale.)... • -
-
O I, as owner of the property, am exclusively contracting with licensed contractors to:con-
Plumbing
• slruct• the project. (Sec. 7044, Business and Professions Code: The Contractor's- License Law
does *not apply to 'an owner of property who builds orimproves, thereon, and who contracts for '
S.M,I.
- - -
- such projects with a contractor(s) licensed pursuant to the Contractor's License. Law.) -i • -
-
Grading
• El I am exempt -under Seca B. & P.C: for this reason
Driveway Enc.
' Dateowner
Infrastructure
WORKERS' COMPENSATION DECLARATION
" Thereby 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
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,,
}} _ t {• ^ n
„�,_� R ,t,,• F+�} - �'P»,t _ .^ A 7
employ any person in any manner so as to become subject -to -the Workers'Compensationwa-
Laws of California.
Date Owner
NOTICE TO APPLICANT.- it, 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.f.rom.Center Line '
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from•Center..Line
I here6yaffirm'that there'is a corislruction lending agency for the performance of the
"
r
whic
. work for h 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 it work thereunder is suspended for 180 days:'
)meg t
I. certify that I have read this application and state that the above information is correct.
Issued b y
Date Permit '
agree to comply with all city and county ordinances and state laws relating.lo building
'
s
consWction, and hereby authorize representatives sof 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. ® $
2ND FL. SO. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CARP. 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 APP./EQUIP.
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
0
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
v1ECH.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 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.
FRAMING
FINAL INSP.
ROOFING
0
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALLSk
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL