002037 (SPIN)44
P.O. BOX 1504 -No.W
Building 78-105 CALLE ESTADO
Address 1QWM= 54,-175 Avenida DJAMLA QUINTA, CALIFORNIA 92253
Owner
00203
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address 54-715 AVE-Iddd3 Diaz
A.P. Number '
City Zip Tel.
La fid# 922 Legal Description
Contractor Project Description
Address
Zip
State Lic.
& Classif.
Arch., Engr.,
Designer
Address
t'lly
Lic. # Sq. Ft. No.
Size Stories
Tel.
INew ®:. Add ❑ Alter ❑
No. Dw.
Units
Repair ❑
Demolition ❑
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
^•
I hereby affirm that I am licensed under provisions of Chapter (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
�. effect.
_
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License.Law for the following
Estimated Valuation
reason: (Sec. 7031.5,Business 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
J requires the applicant for such permit to rite a signed stalement that he is.ficensed pursuant to
-
• PERMIT
AMOUNT
1 the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
j Division'3'of the Business and Professions Code, orthat.heAs exempt therefrom, and the basis
for the alleged exemption. Any violation of Section' 7631:5 by -any applicant for a permit
Plan Chk. De p . •_
'
subjects the applicant to a civil penally of not more than five hundred dollarsyS500). '
O I, as owner of the property, or my employees with wages as their'sole compensation, will
Plan Chk..Bal.,
Const.
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
Mech.
'
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 safe. If, however, ,the building
Electrical
i 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 (he purpose of safe.) - . - '
Plumbing
0 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'lo an owner of property who builds or improves thereon, and who contracts for
S.M.I. - -
-
' such projects with a contractor(s) licensed pursuant to the Contractor's License Law.), -
i ❑ 1 am.exempt under Sec.. B. & P.C. for this reason
,.
Grading
Driveway Enc.
Date Owner IV-� 4 f"
Infrastructure
0 lwliar= ajxv+`y 111JUaUU
rrr
WORKERS' COMPENSATION DECLARATION
I' hereby affirmthat I have a certificate of consent to self -insure, or a certificate of
v
Worker's Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is.filed with the city. ❑ Certified copy is hereby furnished. .
TOTAL
1000ou
CERTIFICATE OF EXEMPTION FROM
_ WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed ff 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
i subject to the Workers' Compensation provisions of 'the Labor Code, you must forthwith
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
Side Street Setback from Center Line
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 Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE
Issued by:
Validated by:
INSPECTOR
Dates"6-86 Permit -
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 ordination and state laws relating.to building
construction, and hereby authorize representatives of .this city to enter the above-.
mentioned property for inspection purposes. .' 1 - J
Signature of applicant ?� r ~ Daler/-
Mailing Address r'
Validation:
A4168
2 6 J 00.00 CR
City, State, Zip
HARD COPY
T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT. ®
GROUT
WATER HEATER
WALL SO. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
SO. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
LATHING
SO. FT.. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE i 7: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.IEOUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS,
GARDEN WALL FINAL