9425 (SFD)Tait 4 4 QUM&
address 50-15.5 Doral Street
M. J. Brock
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing I
Address
City lZip ' ITel.
Contractor
SAME
Address
Zip
State Lic. City
& Classif. 5 412636 Lic. # 1890
Designer
Address Tel.
City Zip State
• 'I,/- I Lic. #
�/ LICENSED CONTRACTOR'S DECLARATION rr
I herebyy:affirm that I am Iicinsed,-under•provisions of Chapter 9 (commencing with Section
7000), of'Divlsion 3 of the Business and Professions Code`,' and my licensecis`in full fo ceand%
effect.�rt?_737cY
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I.hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Buslness and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to -its ksuance 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
Oivision'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 rive hundred dollars ($500).
t- 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 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 wig 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 or 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. 8 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.)
Policy No. company
gCopy 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 pparson in any manner so as to become subject to the Workers' Compensation
Laws of Californla.
Date Owner
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you shoukf 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. 9425
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description Rrn-k 14#r M.n.cx
Project Description Lot 59 Model 4Bk
Sq. Ft.
Size 3017
No. No. Dw.
Stories Units
New ❑ . Add ❑
Alter ❑ Repair ❑ Demolition ❑.
Estimated Valuatio218,761.00
$ j X61 • 00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
859.38
Const.
1056.00
Mech..
85.50
Electrical
151.34
Plumbing
180.50
S.M.I.
15.33
Grading
Driveway Enc.
Infrastructure
4922.12
Art in Public 296.90
OASW) io 00A 04-01-914. 14
TOTAL
4567,P07 3utWt a ��u,.itt
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
IST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT.
ROUGH PLUMB. BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
DRAINAGE PIPING
CAR P. SO. FT. ®
,AS (ROUGH) �/. ` � � METER LOOP
V
WALL SO. FT.
HEATING (FINAL)
DRINKING FOUNTAIN.
SO FT ®
GAS (FINAL) TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER HEATER SERVICE
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
cu. yd.
plus x$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
I OINAL INSP. !/ r�-
LAUNDRY TRAY
AIR HANDLING UNIT CFM
OOFING .-G ...-C4 I
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 ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® Vyc
HOUSE SEWER
LATHING
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
JAROUND PLUMBIf1 `fa Z -IR UNDERGROUND
A.C. UNIT
COLL. AREA
194,49�AB GRADE 5 —16 -q
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
''//FORMS
14OUND. REINF. `
,AS (ROUGH) �/. ` � � METER LOOP
V
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
=$
LUMBER GR.
I OINAL INSP. !/ r�-
RAMING &W
FINAL INSP.
OOFING .-G ...-C4 I
7- o w,en� obi- IZc�
_ I�i`/ l �' 4kV
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
', f% INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
-W &AV
of
OrrTt-L.
ug
Tint of Ka Ouinta
s
-
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 50-155 Doral
Use Classification SFD Bldg. Permit No. 9425
Group R3 Type Construction VN Fre Zone Use Zone R1
Owner of Building M. J. Brock Address 3380 Shelby Street '
City Ontario, CA 91764
By: Lonnie Day
Dote: 11/19/91 '
Building Official
POST IN A OONSTICUOUS PLACt
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