07687 (SATT)44a
9MA iw
P.O. BOX 1504 No:. 07687
Add ® L
Building C
g AV -47(i Vane LA QUINTACAL CALIFORNIA 92253
fess y
Owner ... I
Mailing
Address C4 r '
A 9M
City.. .
Zip Tel.
AIm 92260
fR. Desert W-2828
r;•
[LCO.ntractor ,
fttianal Land & Mortgage
Address
Saw
City ' izip Tel.'
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
*} LICENSED CONTRACTOR'S DECLARATION
` effI herebyyfirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7000) of�Division-3 of the Business and, Professions Code, and,my tic nse is in full fore a d
I r` 1( I OWNER., -BUILDER DECLXRATION
' I hereby affirm that,l,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, alter, improve, demolish, or repair any structure, prior to its issuance also
1, 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 theBusiness and Professions Code, or that. he is exempt therefrom, and the basis
s for 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 wages as their sole compensation, will t
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and .4
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 improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
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
such projects with a contractor(s) licensed pursuant to the. Contractor's License Law.)
0 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
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.)
i Policy No. Company .
❑ Copy is.filed, with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
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: It, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
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.)
Lender's Name
Lender's Address
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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
11LDING: TYPE CONST. OCC: GRP.
P. Numberfl I.iec�
gal Description Tract 255€1
oject Description Pham- 2H Plan 2dR
ZONE:
t7
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
FINAL DATE
INSPECTOR
Issued by:
Date 4/25/Permit
Validated by--
yValidation:
Validation:—
Estimated Valuation
f
Y
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
554.22
Const.
681.510
Mech.
60.00
lElectrical
87.25
Plumbing
120. so
S.M.I.
r.
Grading
Driveway Enc.
Infrastructure
2,513.57
1.266.79,
Less Credit
1,256.79
"
r
•
TOTAL
2,760.10
J0 )
REMARKS
a3
xA 6�tl 4,";
ZONE:
t7
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 4/25/Permit
Validated by--
yValidation:
Validation:—
t +:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOB]LEHOME 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
FLOOR DRAIN
MECHANICAL FEES
PLUMB.
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FOUND. REINF.s'
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
GROUT
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3Yic
HOUSE SEWER
WATER SYSTEM
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
C&OUND PLUMBIN 5,ee)
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
//ROUGH
Gd'�6EWER OR SE �l�
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.s'
&AS (ROUGH)F--S/ dQA
// JJ
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ —plus—x$_=$
LUMBER GR.
INAL INSP`Q—/ 2 -9v—
f FRAMING i
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
Vvi
ATHING
MESH
INSULATIONISOUNDE —4?
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL