001902 (SIGN)Building
Address 48-680
Owner
Mailing
Address 305 LYttOn . .
CityZip Tel.
Palo Uto 94901
Contractor
Address
ty )Zip Tel.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 9225.3
State Lic.- I City
& Classif. Lic. #
Arch.; Engr., . Lazb
Designer
Address Tel.
.. . .. 260 Chli ffl &TAa ft t (415) 986--4260
City Zip State
sn, ftancisW I • 941U Lic. #
LICENSED CONTRACTOR'S DECLARATION,
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Divislon 3 of the Business and Professions Code, and my license is in full force and
�` /F/1.'. 1..f[�
effect. A"/
OWNER-BUILDER DECLARATION'
I hereby affirm 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 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'ctvII penalty of not more than five hundred dollars ($500).-
0
$500)—
O 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 Contractors 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 ofsale.) -
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
strucl 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.) -
0 I.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.)
Policy No. Company
❑ Copy 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 the 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 Exemptionyou 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 sof this city to enter the above•
mentioned property for inspection purposes. _
Signature of applicant \/ Date's I' f 14'_�•`y
Mailing Address ' 's
City, State, Zip
HARD COPY
No.
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 617—M-004
Legal Description
Project Description 'i<li7 t -1W70«
2 on the W/S of Ave. • .5
2 M ifi S . of Jef f Lmrsan
sipse 12,,11 he roatl-naaaA nithiin +i==n±b
Sq. Ft. No. No. Dw.
Size Stories Units
New1f] Add ❑ Alter ❑ Repair ❑ '
Demolition ❑
ZONE:
BY:
Minimum Setback Distances:
--Six pt w bMVxUWV > 2 Ilk fes# dia..
Rear Setback from Rear Prop. Line
r _
Side Street Setback from Center Line
Estimated Valuation
Side Setback from Property Line
PERMIT
AMOUNT
Plan Chk. Dep.
Dated 1845 Permit
Plan Chk. Bal--,--"
Const.
2t.
Mech.
11 20 34073 CK
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure _
TOTAL
14fa 73
REMARKS
sipse 12,,11 he roatl-naaaA nithiin +i==n±b
. 'tmf %yr"1'k "'rf%3" 11- IQQC; T4"10M.0Q Ai
Xelamst
&' Ulm Mictersim is cmantll d.
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:
Dated 1845 Permit
Validated by: '
Validation:
A3368
11 20 34073 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
2ND FL. SQ. FT.
FOR. SQ. FT. @
GAR. SO. FT. @
CAR P. SQ. FT.
WALL SO. FT. @
SQ. FT, @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
I ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING-'
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO F7
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)
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.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
NSYt(:1 Vii'b WUNA 1 UKLWINI I IALb.
GARDF,'N WALL flg6L'•_, .