12345 (SFD)P.O. BOX 1504
No. 12345
Building 78-795 Grand Traverse 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner Comunity . Sank
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address 100 E. Corson St. 769-652-006
A.P. Number
City Zip , Tel. Lot 49 Tract 25389
Pasadeta, CA 91103-383 X818) 568-213 Legal Description
Contractor yr r. ' Project Description SFD Plan 2
3ascoxp`rii
Adgpss& 11 Cwan
tri ' Ctib Dr.', Somite A
N
C'tyeZip T I.'
rwida Dnner, 92201 619) 345-809
State Lic. City
&•Classif. $ 520826 Lic. # 1.148 Sq. Ft. No. No. Dw.
Arch.; Engr.,Size 2299 Stories Units
Designer Da:aielion AS Si ociates New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
AM,scy Corporate Park 1710 474 -6030
Cit Zip State
Iyry e', CA 92714 Lic. # C-4829
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my lic nse is in full force and
effect.g.. •x-c sT� v'� _ r//,-J"5-�;
SIGNATURE 1/ .01 AV, DATE '
to OWNER-BUILDER DECLARATION Estimated Valuation $179t835.00
I h reby 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 PERMIT AMOUNT -
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 Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Plan Chk. Bal. 760.29
.0 I, 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 Const. } AA y. ry 0
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, Mech. $3.00
provided that such improvements are not intended or offered for sale. If, however, the building t
or improvement is sold within one year of completion, the owner-builder will have the burden Electrical 154.33
of proving that he did not build or improve for the purpose of sale.)
01, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 174. 00
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Laws 1
does not apply to an owner of property who builds or improves thereon, and who contracts for S. M. 1. - 8.00
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading 20. 00
❑ I am exempt under Sec. B. & P.C. for this reason
Driveway Enc. .00
Date owner Infrastructure .00
Axis in Pubs c Places 199.59
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.)
Polof Company
316opy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 2 ,325. Iii
CERTIFICATE OF EXEMPTION FROM REMARKS d.Y Tra u-crU1ctu're tees Pala on
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation eri i t E40 • Vb 1Z•
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 ZONE: BY:
subject 'to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) Side Setback from Property Line '
Lender's Name
Lender's Address1 ° t
This is a building permit when properly filled'out, signed and validated, and is subject to FINAL DATE • INSPECT4R
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'. It
Iagree to comply with all city and county ordinances and state laws relating to building 1
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes. Validated by: A uu
i
Signature of applicant Date
Mailing Address Validation: S
City, Stale, Zip +
By
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. $
UNITS
�
�
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SO. FT. ®
-$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
'
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIREPLACE
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
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
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 APP.IEQUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
P.M.•,�."F.�t`� �.
� N ar�rg;e}q jwy� dMtfs!'•S:��i/"r''Qef•c •• .
CITY OF LA WINTA
a DEPARTMENT OF PLANNING & DEVELOPMENT
'7%'? -7153 BUILDING DIVISION
s -'2w
24-HOUR NOTICE FOR INSPECTIONS
a UU01TA
Owner Community Bank QV
Contractor J a s c o rp
Permit Number 12345
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
"ADDRESS 78-795 Grand Traverse
SFD Refer to permit no. 9827
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC'
ROUGH PLUMBING
ROUGH GAS & GAS TEST /l c
HEATING & VENT -A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP z— -�'
GROUT ❑ 4' ❑ 8'
FRAMING
1 INSULATION ;) /
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR /(,�G
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL — Ceo<LiL
PLUMBING
FINAL GAS TEST
HEATING'- A/C
HOUSE NUMBERS
JOB COMPLETED /
TEMP POWER j
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
4188 y�