04255 (BLCK)rri
P.O. BOX 1504 °
Building �+� to QUINTA, CALIFORNIA 92253
Address _
Owner r
2 � � Wootf3rn - Am7C'J can eO>< st'. coy BUILDING: TYPE CONST. OCC. GRP.
aha Majiing.y
)Address x '� .®. O?S 1 �9 A.P. Number 774-174-012
,Cit zip Tel. , •
intra, 92253- 564-74"11- Legal Description
t
Contractor. F; "Ret�i�,t1�.ng 'Fall 100, X' 2' �
f , Gary Reynolds Project Description
Address"- «'�• . �.
P.210. BOX 897
a City Zip Tel.
1flf�f �°t +$Z a i€ 343fZ67Z
State Lic ) - City
& Classif. �% Lic. # Z Sq. Ft. No. No. Dw.
Size. Stories Units -
Arch., Engr.;'
Designer • New ❑ Add O Alter ❑ Repair ❑ Demolition O
'{` Address, ; - Tel.
City JZip. ... State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm thatI am licensed under provisions of Chapter 9 (commencing with Section ., .
7000); of Division Tof the Business and Professions Code, and my license is in full force and
�` :effect:
�r SIGNATURE'- DATE -
k,; pt A "� OWNER-BUILDER DECLARATION
9 ..t_, t. Estimated Valuation® if .',I herei affirm that. 1-am- exempt from the Contractor's License law for the following $t ,
reason. •(Sec:;,.7031.5,&isiness and Professions Code: Any city or county which requires a - • y,
+ parmft'to..construof„alter, improve,' demolish, or repair any structure,. prior to ds issuance also _
requkes the epplfcanr I 'such, permit to file a signed statement that he'!s licensed pursuant to PERMIT AMOUNT -
the provisions otthe.Contracfor's Ucense Law, Chapter 9 (commencing with Section 7000) of -
f sion 3 o!_the Business' and, Pro/essions Code, or that he Is exempt therefrom, and the basis - -- - v
"lor,the• alleged exemption:-Any violation o/•Section 7031.s Dy 'any applicant. for a permit Plan Chk.Dep.
S • suD)ectsthe applicant to a;clJl1 penalty of not more than live hundred dollars (ES00). a .
`. ❑ I, as owner of the property, or mg employees with wages as their sole compensation, will Plan Chk. Bal.
do'the work, •and the•structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. r'' •°4. i
Pro/essions'C ode: -The; Contractor's License Law does not apply to an owner o/ property who -
r• builds or fm proves,,thereon and who does such work himself or through his own employees,Mech.
'provided that such Iimpiovements are not intended or olfered.lor sale. If, however, the building T
•.0 or Improvement , is sold.z w(thin , one year of completion, the owner-builder will have the burden Electrical
i'• ` of proving that he did norbuild or improve for the purpose of sale.)
0:1, 'as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing i
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 $,M.I. - Offa }
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -4
Grading
❑.l.am exempt under Sec.-B. & P.C. for this reason
Driveway Enc. x
Dale' Owner Infrastructure _
t WORKERS' COMPENSATION DECLARATION +:h”
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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
` CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
+ (This section - need not be completed i/ the permit is for one hundred dollars (8100) valuation
or less.) A.
11 certify that in the performance of thg work for which this permit is issued, I shall not .;lS,M x 1•bc -:;-a n: S•+':n > ea.K
employ any person in any manner so as to become subject to the Workers' Compensation c; a�s:rtr ,r=tta ria t 'v •+. y a y ;f R
Laws of California.
.'Date ' Owner
NOTICE -•TO_APPLICANT. I/, after making this Certificate of Exemption you should become ZONE: BY:
Ssubject to, the Workers'. Compensation provisions.of .the Labor Code, you must forthwith MIs:
r11R1Um Setback Distance
comply with such provisions or this permit shall be deeed revoked. Front Setback from Center Line
` Rear Setback from Rear Prop. Line
.CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) $ide Setback from Property Line
Lender's _.Name -
Lender's. Address
,This is a building+permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 180 days.
I certify that I, have read this application and state that the above information is correct.. Issued by: ' Date Permit
I agree to comply with all city and county ordinances and state laws relating to building.
construction, and hereby authorize representatives of-this city to enter the above-
mentioned property for Inspection purposes. Validated by:
'Signature of applicant Date t r
Mailing. Address Validation:___
City, State,. Zip
a
f '' t` WHITEFINANCE PINK APPLICANT GREEN BUILDING, GOLDENROD ASSESSORS OFFICE HARD COPY -FILE
4• :� � � ,. .m 1 j o
, - -31.•_ 'S'.JY,...C.,r L 4k._ �' ::.?t i s w fi`-.�F 3M ,�. •,R { c t• +.. ..M i i�.
,;,:__ r '^'1,t ar. .Y-.•f ...r._'-, i'� ,.(.•.+.. �..�...._. t":_ -.:, .. +�.: ,- "'iti,.r,�i::. .�.. ."..._-.:. .T.:, 2 _ _ -..r .. tv_?'x .. .. .-_ *,i .. _ ,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT (a S
UNITS
COLL. AREA
2ND FL SO FT. @
fI
YARD SPKLR SYSTEM
BONDING
MOBILEHOME SVC.
BAR SINK
POR SO FT. of
SEWER OR 6 I A
GAR$p. F7.
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
DRAINAGE PIPING
CAR P. SO FT. ra
HEATING (FINAL)
OTHER APP.IEOUIP.
WALL SO. FT. a
8�
DRINKING FOUNTAIN
SO. FT. ra
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTONDISHI
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
FIREPLACE
SO. FT. c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID I V: c
SEWAGE DISPOSAL
SO.FT.GAR (g 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEECONST.
FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE ��
fI
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR 6 I A
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
8�
S (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
/"!BOND BEAM ��
'1""
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
= $
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
T
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
-
FENCE FINAL
INSPECTO 'S SIGNATURESIINI ALS
GARDEN WALL FINAL