9424 (SFD)T4'ht 4 4 Q"
Building
Address ss 50--095 Doral Street
Addr
Owner
M. J. Brock
Mailing
Address
City lZip ITel.
Contractor
SAIME
City Izip
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
State Lic. City
& Classif. B 412636 Lic. # 1890
Arch., Engr.,
Designer
Address Tel.
City IZip IState
s' Lic. #
LICENSEDCONTRAACTOR'S DECLARATION
I herebyy;affirm,that I am Ilcensed under provisions of Chapter 9 (co
7000) of Division 3 of tlie'Business and Professions Code, and my lic
effect
SIGNATURE _ DATI
OWNER -BUILDER DECLARATIDN '
I hereby affirm that I am exempt from the Contra tors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, atter, 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).
O 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 taw 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.)
❑ 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.)
P014No. Company
L7`Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed 11 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 anyperson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT. If, afar 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
1 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. 9424
BUILDING: TYPE CONST.
A.P. Number
Legal Description Rrnr-k
Project Description
OCC: GRP.
F1nTnP_a
Lot 56 Model 4C
Sq. Ft. 3011
Size .
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ 'Demolition ❑
Estimated Valuation218,761.00
r
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
859.36
Const.
1056.00
Mech.
85.50
Electrical
151.34
Plumbing
180.50
S.M.I.
15.33
Grading
Driveway Enc.
Infrastructure
4922.12
Arc in Public
296.90
f Y.r7 6 t% A^.1 'T 44
4
.AS
4
,@l.!�r
p "lASI -y
� iQ A I .,W 75-6e,0e
TOTAL
7567.07
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 DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. Fr. ® $
UNITS
ROUGH PLUMB. BONDING
2ND FL. SQ. FT.
STORAGE TANK
YARD SPKLR SYSTEM
POR SQ FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. Ff. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
REINF. STEEL
DRAINAGE PIPING
WALL SO. FT.
DRINKING FOUNTAIN
SO FT ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
LUMBER GR.
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
SQ. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
SQ.Ff.GAR ® V4c
HOUSE SEWER
FINISH GRADING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
I CONST. FEE JELECT.FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
OUND PLUMBI* aOJ UNDERGROUND
A.C. UNIT
COLL. AREA
/
6i4686BGRADE j —` 3 (
ROUGH PLUMB. BONDING
HEATING (ROUGH)'
STORAGE TANK
FORMS
EWER ORS4/8j1& ROUGH WIRING
DUCT WORK
ROCK STORAGE
y
F UND. REINF.ly_ /
(
(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.
INAL INS//-64ql
MING �f '�3 I I
FINAL INSP.
ROOFING Q �U -cn `
M k �I /�
V
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
a'
1/ THING
MESH
ttANSULATION/SOUND �� 3 01
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESfINIT1ALS
GARDEN WALL FINAL