001767 (SOL)Qum&.
P.O. BOX 1504 No. 001767
Building 46-83 a` &dn9t LA QUINTACCALIFORNIA92253
Address '
Owner
Mailing •
Address 4,
City
Zip
Contractor
Address
1808 -3 cmamerm inter West
BUILDING: TYPE CONST. OCC: GRP._
A.P. Number"'"
Legal Description lam' 65
Project Description
State Lic.
City
& Classif..Lic.
'�
#
Sq. Ft.
Size
No. No. Dw.
Stories Units
:. 'Arch.,-Engr.,
Designer
New Q Add ❑
w
_.. .
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
_
Lic. #-. .
j/ 'LICENSED CONTRACTOR'S DECLARATION .„
hereby affirm that Lam licensed under provisions of Chapter 9 (commencing with Section -
7000). of Division 3 oflthe Business and Professions Code; and my license is'in full-force,and '
effect.^
,.
.
SIG_NATLJRE '4 'S DATE
- OWNER -BUILDER DECLARATION E_
I hereby affirm that I am exempt from the Contractor's License Law for.the following
reason: (Sec, 703,1.5,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
requires the applicant for such permit 'to* rite a signed statement that he. Is licensed pursuant to
the provisions or the Contractor's License Law, Chapter 9 (commencing* with -Section 7000).' of
' Division 3'of the Business aid 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)..
. ❑.1, as owner of the property, or my employees with wages.as their sole compensation, will
Estimated Valuation
-
!.0 ftfst
$5..4.737��0 -
-
- PERMIT -
- -
- • • AMOUNT,
'
.Plati .Chk. Dep.
...
Plan .Chk. Bal..
Const.
.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
.. Professions Code: The Contractor's License Law does not apply to an owner of -property who
"Mech.
-
builds or improves thereon and who does such work himself or through his own employees,
provided that such, improvements are not intended or offered for sale. If,. however,* the building
•' Electrical'
or improvement -is sold within one year of completion, the owner -builder will have the burden _
of proving that he did.not build or improve for the purpose of.sale.).
Plumbing
" 20.00
0 I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Seca 7044, Business and Professions Code: The Contractor's; License Law,
does not apply to an owner of property who builds or improves thereon, and who contracts for
S:M•l;
-
- such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under.Sec. B. & P.C. for this reason
.
Grading
Driveway Enc.
Dale Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION `-
' 'I hereby affirmAhat I'have a certificate of consent to self -insure; or a certificate of
-• -
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O, Copy is filed with the city., O Certified copy is hereby furnished.,, '
TOTAL
CERTIFICATE OF EXEMPTION FROM—
WORKERS' COMPENSATION INSURANCE
REMARK$
-
. (This section need not be completed if the permitis 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. •
ZONE:, BY:
:Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
• 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.).
Side Street Setback from Center. Line
Side Setback from Property Line
Lender's Name
Lender's Address
This is a building permit when property 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.
Signaturebf applicant 4 1 - - Date
Mailing Address L r ��
'FINAL DATE
Issued' by:
Validated by:.
Validation:
A2.992
INSPECTOR '
Date!P-M RS Permit
1U 28 . X0.00 CK
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO. 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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROUGH WIRING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAS (ROUGH)
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
WATER HEATER
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
BOND BEAM
SO.FT.GAR @ 3/4c
HOUSE SEWER
GRADING
cu. yd.
$ -Plus-X$-=$
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
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
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.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
DFC
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INZW tt:I UM'J .11"NA 1 UMLWINI I IALb.
GARDEN' WALL FINAL