11115 (GAS)j
Buildin
Address • .� � � Wcizhingtor
Owner
Kevin Leonhard
Mailing
Address Sable
City .L. ovinta ZIp9225.3
Contractor
.•-Owner/Buildar
�44
P.O. BOX 1504 N O .
-LA QUINTACCALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Tel.
360-4122 Legal Description
Project Description
Gas •crest
Address .._.:
r
City. ..
Zip'
Tel.:
State Lic.
City
& Classif.
Lic. #
Sq. Ft.
No.. No. Dw.
Size -
Stories • Units
Arch:, Engr.;
Designer -
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION -,
I hereby affirm that I am licensedunder provisions of Chapter 9 (commencing with Section'
70110) of Division 3 of the.Business,and Professions Code; and my license is in full force and
'
.•
SIGNATURE - DATE
OWNER -BUILDER DECLARATION
I hereby affirTn that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city _or county :which requires a• • '
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
' requires the applicant for such.permit to file a signed statement thathe 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 . permlt
` r subjects the appffcant to a civil penalty of not more than five. hundred dollars ($500). -
` p I, as owner of the property,. or my employees_ with wages as their. sole compensation win
`do the work, and the structure is not intended or offered for sale.'(Sec:, 7044, Buisness and '
Professions Code: The Contractor's Licdoes not apply to an owner of property who -.
Estimated V81UatlOn
-
-. -
-
- ••
PERMIT
, t'•
- - • AMOUNT
Plan Chk. Dep. .'
. `Plan Chk. BaL
-
°OOnSt.
15.00
Mech.,at', a .o�'.
- -
.
• 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 burdeno
_ of proving that he did not build or improve for the purpose of sale.) .
ElectflCai'
< -
Plumbing " w..
- S x, 18.50- '
l, as owner of the property, am exclusively contracting with licensed contractors to con- .
• `fStruet -the project (Sec. 7044, Susioess-.and Professions Coder The Contractor's License Law
do es not apply to an owner of property* builds or improves thereon, and. who contracts for
such projects with a contractor(s) licensed pursuant to the Contr"actor's License Law.) , - -
t `under Sec. f '
❑ I am exam B. & P C fo
p r thls reason • '
//',.
S, M.I.. •
_
- . • .
Grading
_
Driveway Enc.
-DateOwi er� � - rt_ � ---
Infrastructure
: WORKERS' COMPENSATION DECLARATION
1 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
O Copy is filed with the ci O Certified co
city. copy is hereby furnished.
CERTIFICATE OF EXEMPTION; FROM
WORKERS' -COMPENSATION INS r
INSURANCE
(This section need not be completed if th 'permit is /� one hundred dollars ($100) valuation—or
I certify that in the performance of�p work fonwhi h this permit is issued, I shall not
=any ppeerson in any mannerso!as�to•�ecome sub'ect to the Workers' Compensation
Laws of California %%�
Date 'Ownei (.f .s-
T ( a.�( n 6 r6 -Y-2. -
�
TOTAL
33.50 ,
REMARKS
.. . ,
•�
NOTICE TO APPLICANT: fl° after making this' Certificate of Exemption you -should become
subject to -the •Workers' CompensaUon provisions 'of theLabor Code, you must forthwith
comply witlrsuch provisions orthis permit shall bedeemed revoked. -'
..ZONE: ' - BY:' `
- - - -
-,Minimum SetbackDistances: .,. '• .,. - - ''; -�•
Frontaetback from Center Line -
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY'
I hereby affirm that there is a construction lending 'agency for theperformance of the
work for which this. permit is issued. (Sec. 3097, Civil Code.)
Side Street Setback from Center Line
aide Setback from Pfoperty'Llne ?
Lender's Name
Lenders Address
FINAL DATE
_ INSPECTOR '
+
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.-.
_ Issued by:-
Validated by`.
Date '.Permit''
?. -� �• '
Signature of applicant Date
Mailing Address `
Validation'
'
,
r
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ, FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
SQ. FT. ® c
BATH TUB
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ic
HOUSE SEWER
FRAMING
FINAL INSP.
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
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)
C METER LOOP
2�/
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.
FINAL INSP.
FRAMING
FINAL INSP.
r
ROOFING
ter;
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC. 4/v 4
FENCE FINAL
INSPECTOR'S SIGNATURESIINMALS
GARDEN WALL FINAL