12803 (SFD)Building 78-350 La PalMa; Drive P.O. BOX 1504
78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner Century Homos CO%l3 auni' ies
Ivlauing
Address 1535 South "DR Street, Ste. 200
City Zip Tel.
San Bernardino, CA 92408 (909)381.6007
Sam
Address
Zip
State Lic. B 314473 ( City 2120
& Classif. Lic. #
Arch., Engr.,
Designer Benjamin Aguilar & ASSOC.
ft) Pas ser -o Avenue TeJ•710 359-6066
�R versi4s CA zip 92505 LLiict#
LICENSED CONTRACTOR'S DECLARATION r
I hereby affirm that -I am Iicensedrundeprovisions oof Chapter 9 (commencing with Section
,Il7000) of Division 3 of the Busir�essarid'Professions CoAe and-fny license is in full force and
effect.,- ✓_.✓ ' ��"
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, 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, and the basis
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
do the 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 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.)
O 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 -ompensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy o. Company
Copy is filed with the city. O 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., If, 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 -of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
No. 12843
BUILDING: TYPE :CONST. • OCC. GRP.
A.P. Number 604-161--005
Legal Description Lot 70 Tract 23269 Phase 7A
Project Description SFD Plan 3X
La Quinta
Del Rey
Sq. Ft.
Size 1606
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ "Demolition ❑
Estimated Valuation
$93,171.00
PERMIT
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
268.13
Const.
612.50
Mech.
49..00
Electrical
127.75
Plumbing
144.00
S.M.I.
9.40
Grading
20.00
Driveway Enc.
.00
Infrastructure
2,058.10
TOTAL
3,538.88
3,288.88
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 DA
Issued by
Validated
Validatior
y
CONSTRUCTION ESTIMATE
z NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
r+ w
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
FOR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CARP. SO. FT. ®
I
GAS (FINAL)
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ. FT: ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEESWATER
GRADING
cu. yd.
$ -plus-x$
SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
I
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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 ® 1114 c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING 0
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO !FEE!MMECH.FEEPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING11pir
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 APPJEQUIP.
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
I
� � f � 9 � 6
FI}
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 0
MESH
INSULATION/SOUND q
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIAIS
GARDEN WALL FINAL
(�it� of '14tt (QUinta
�ul�tn� rtn� s�sr��et� 34*11*S*nn
This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building!
Code certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City regulating building construction or use. For the following:
BUILDING ADDRESS 78-950 LA PALMA `DRIVE
Single Family Dwelling 12803`
Use Classification g y 9 Bidg. Permit No.
Group R3 Type Construction VN Fire Zone Use Zone SR
Owner of Building Century Homes .Communitid>oress 153 SoLth "n" Street, Ste_ 2nn
City San Bernardino, CA 92408
By., Bruce 1 1 _ i
Dote: July 8, 1994
Building Official
POST IN A 001I111"000US PLACE