9423 (SFD)T a ity/ 4 4Q�rw
Building
Address 50-175 Doral Street
Owner
IVA• V • 4yA V�,rd1
Mailing
Address
City jZip ITel.
Contractor
SAME
p
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
& Classif. 3 412636 Lic. # 1 850
Designer
Address Tel.
City Zip State
% Lic. #
r ` LICENSED CONTRACTOR',S DECLARATION
I hereby affirm that I am licensed undt;r•pmisions'of Chapter 9 (commencing with,Secteord
7000) of. Division13 of the Business,and`Professions Code, and my,license is in full'force,and
J1VrvAl u.t
t r,' OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's 4(cense Law for the following
reason: .(Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit td 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 rive hundred dollars.($500).
❑ 1, 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.)
O 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
IDate 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
OeCopy is filed with the city. ❑ 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 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 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
Ihereby 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.
BUILDING: TYPE CONST. OCC: GRP.:
P. Number
9423
Legal Description Rrnc!k Rnmps
Project Description Lot 60 Model 3A
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:
Sq. Ft. 2740
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ -Demolition ❑
I
Estimated Valuation
200, 357 00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
7.10.03
Const.
993.00
Mech.
79.00
Electrical
142.46
Plumbing
162.50
S.M.I.
14.07`
Grading
Driveway Enc.
Infrastructure
4508.03
Art in Publid
250.09
AffIeNl A / A 19(.7 OA -015-911 14
1l(} CASH I IL IAL g 66!0.'Y_�
TOTAL
6859.95
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. FT. ® $
UNITS
��//��SETBACK
(A4t,B GRADES l 01,
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
OTHER APPJEOUIP.
DRAINAGE PIPING
WALL SO. FT.
TEMP. POLE
DRINKING FOUNTAIN,
SO FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
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
LAUNDRY TRAY
AIR HANDLING UNIT CFM
VENTILATION
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 314c
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 ELECTRICAL HEATING & AIR COND. SOLAR
OUND PLUMES G .q'
UNDERGROUND
A.C. UNIT
COLL. AREA
��//��SETBACK
(A4t,B GRADES l 01,
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
�//FORMS
I4OUND. REINF. —, �� (
S (ROUGH)/6V_ /3�
(
METER LOOP
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.
NAL INSP.` — 1� I
�n
FRAMING — 4/-0 I
FINAL INSP.
OOFING l `�I
PTLZ
(��/ A --
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
/w
L%7LATHING -- %;L I
MESH
UI,INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL