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14566 (SFD)Building Address Mailing Address 1535 South "W" Street, Ste. 200 CityZip Tel. San Bernard CA 942408--(909)381-6007 Contractor Sam4b Address .. P.O. BOX 1504 No. 14566 78-495 CALLE TAMPICO 79-305 Desert Strea n, fir. LA QUINTA, CALIFORNIA 92253 Cen ,ury Homes Comuni ties BUILDING: TYPE CONST. � OCC: GRP. R3 A.P. Number Legal Description Lot 24 Tract 23935-5 Phase 3A Project Description SFD Plan U The Cla ssics _.t Tooaz L:Ity zip I el.; ZONE:' State Lic.3 &ClaSsif.. '>f3 1��%3 City Lic. # li} Sq. Ft. Size . L845 • No. No: Dw. Stories Units Arch., Engr., Jaen 'amin A utlaA Assoc. Designer 3 New ❑ Add ❑ Alter ❑ ". Repair ❑ Demolition ❑ cir sPaassero' Avenue '6.14) 359-6066 _ FINAL DATE .. City Riverside, CA, Zip 92505 State Lic. # LICENSED. CONTRACTOR'S DECLARATION I I hereby affirm that I am ligensed under provisions of Chapter 9 (commencing with Section - I 7000) of Division 3 of he Qsi ass Professio Code, and my license -is in fulyforce and effect.: ✓ SIGNATURE e 411 DATE OWNER -BUILDER DECLARATION . I hereby affirm that I am exempt from the Contractor's License Law for the following. . reason: (Sec. 7031.5,Suslness and Professions Code: Any city or. county which requires a permit to construct, after, 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 Professkms 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 rive 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; Bulsness 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 orimprovement is sold within one year of completion, the, owner -builder will have the burdenElectrlCdl, of proving that he did not build or knprove for the purpose of sale.) - O 1, 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 contractors) licensed pursuant to the Contractor's License Law.) O I am exempt under Sec. B. 8 P.C. for this reason Estimated Valuation - $114 r530.00 PERMIT - AMOUNT ' Plan Chk. Dep.. ' Plan Chk. Bal. -, y ' ! . 74 Const: ,t ^3� A 6 I . V® Mech.- ' ' " ' 49.00 r' �� Plumbing 162.00 S.M.I. q A 11 .45 Grading 20.00 Driveway Enc. 00 Date Owner Infrastructure 2,465.37 Arts in Public Placea 26.32 WORKERS' COMPENSATION DECLARATION I he eby affirm that I have a certificate of consent to self -insure, ora certificate of� Work Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company imJ Copy is filed with the city. ❑ Certified copy is hereby furnished. # TOTAL 4.125.37 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed H the permit is for one hundred dollars ($.100) valuation or less.) ' I certify that. in the performance of thg 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 CertificateofExemption 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. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE - HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION.TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF. THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. This is a building permit when property 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 Validation: ZONE:' BY: _ Minimum Setback Distances: ti 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 �• Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINU FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE 2ND FL. SO. FT. ROUGH PLUMB. BONDING YARD SPKLR SYSTEM STORAGE TANK MOBILEHOME SVC. BAR SINK POR. SO. FT. ® DUCT WORK ROCK STORAGE GAR. SO. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APPJEOUIP. DRAINAGE PIPING CAR P. SO. FT. 0 GAS (FINAL) TEMP. POLE WALL SQ. FT. GROUT DRINKING FOUNTAIN SQ. FT. ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES ROOFING -2 WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER VENTILATION GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY 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. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 114 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/.c HOUSE SEWER 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 nELECTRICAL HEATING & AIR COND. SOLAR 1 » SETBACK GROUND PLUMBINGI UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SE f ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS(ROUGH)_M ETER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. Z FINAL INSP. GRADING CU. yd. $ -Plus-X$-=$ LUMBER GR. FRAMING �% 1 ROOFING -2 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL / LATHING ry MESH INSULATION/SOUND (� J FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL