9827 (SFD)��11 ' 9827
P.O. BOX 1504 P ; G'v 0 . r
Building 78-105 CALLE ESTADO.
Address 78795 Grand Traverse LA QUINTA, CALIFORNIA 92253 �.
Owner
Zs. i7. %BLOC v
AddressMailin33'80 Shelby Stet
Ontario P1p76 4
Contractor
.St°'3at�E
Address
ty lZip
State Lic.
& Classif. B412636
Arch., Engr.,
Designer
Address
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
4-0973 Legal Description Brock Homes
Project Description 2 Lot 49
Lic. # 1090
el.
City Zip_ State
le,
Lic. #
r ✓ LICENSED CONTRACTOR'S DECLARATIO1
I hereby affirm that I am licensed under provisions of Chapter 9 (c
000) of Dlvislom3rof lie Business and Professions Code;'Fand my I
OWN ER -BU ILDER•DECLARATION
I hereby affirm that I am exempt from tite 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 o! 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 civil penalty of not more than live hundred dollars.(S500).
O 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
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,
provided that such Improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year or completion, the owner -builder. will have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with'licensed contractors to con-
struct 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.)
❑ 1 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, ora certified copy thereof. (Sec. 3800, Labor Code.)
Polidy No. Company '
fCopy is filed with the city. O 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, 1 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.
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.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it 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.
Signature of applicant— Date
Mailing Address
City, State, Zip
Sq. Ft.
Size 2204
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ 'Demolition ❑
Estimated Valuation
$ft*222 9a 166,558.00
PERMIT
AMOUNT
Plan Chk. 'Dep.
;
Plan Chk. Bal.
624.91
Const.
£74..00
Mech.
71.00
Electrical
123.85
Plumbing
156..50
S.M.I.
11.69
Grading
Driveway Enc.
Infrastructure
3714
G7.56
ia'
A..t n 'Public 166.40
Arti
TOTAL
5775.91
REMARKS
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: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
B GRADE L t Z_ '
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEQUIP.
DRAINAGE PIPING
CAR P. I SQ. FT.
TEMP. POLE
WALL SQ. FT.
GROUT
DRINKING FOUNTAIN
SO FT ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
=$
FLOOR DRAIN
MECHANICAL FEES
AL INSP. /�j �li % /
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
REMARKS:
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
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
#48OUND PLUMBIN _ -q
UNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE L t Z_ '
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. q
CCC
GAS (ROUGH)) o -V
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.
AL INSP. /�j �li % /
R66 RAMING ' �,
FINAL INSP.
ROOFING _ lew - (
VENTILATION
VA--- 7. ? qA/NC
to e
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
/
VV_LNSULATION1SOUND_7,/?-G
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL