09336 (SFD)r.r-
P.O. BOX 1504�1 N o . 09336
Building 78-105 CALLE ESTADO i
Address 78--805 Grand Traverse A, v(LA QUINTA, CALIFORNIA 92253, 11�
Owner
M.J. ARCCK BUILDING: TYPE CONST.
Mailing OCC: GRP.
Address3300 Shelbv Street A.P. Number
City Zip Tel. `
OnX34 9Ii�� 564_ .� Legal Description Brock RnrvP.,g „
Contractor Project Description mewdlral 1 AR T-nf AA
SRS.
Address t
�. City Zip Tela
State Lic. City
& Classif. No. No. Dw.
i3 4i2�36 Lic. # Sq. Ft.
Size 2264 Stories Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
° LICENSED CONTRACTOR'S DECLARATION
I hereby affirm t6t 1 am licensed,under provisions of Chapter 9 (commencing with Section
7000) of Division'3 of•the 1366inessyand- Professions Code, and my license is in Ell forge an
SIGNATURE" r�/ _ i' ' ! 1 DATE
;_1J OWNER -BUILDER DECLARATION w
I hereby affirm that I am exempt from the"Contractor's License Law for the following Estimated Valuation a
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) or
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). ,
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal A
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
.Professions Code: The Contractor's License Law does not apply to an owner of property who816 sn
builds or improves thereon and.who does such work himself or through his own employees, Mech. .
provided that such Improvements are not intended or offered for sale. If, however, the building Q
or Improvement is sold within one year of completion, the owner -builder will have the burden Electrical - a
of proving that he did not build or improve for the purpose of sale.)
O 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing ;
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 S.M.I. -Zk
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) , 11
❑ I am exempt under Sec. B. 8 P.C. for this reason Grading
Driveway Enc.
Date Owner Infrastructure 3623.34
Acct in Salic 152.59
WORKERS' COMPENSATION DECLARATION
Ihereby 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 Vii'! 5710.30
CERTIFICATE OF EXEMPTION FROM REMARKS
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 rer—
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:?�'��'�Y"�'r
comply with such provisions or, this permit shall be deemed revoked.
ftM
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.). Side,Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
i
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
Mailing Address Validation:.
City, State, Zip
- T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES'
1ST FL. SO. FT. p $
'UNITS
COLL. AREA
2ND FL. SO. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®
DUCT WORK
DRAINAGE PIPING
WALL SO. FT.
AS (ROUGH)
DRINKING FOUNTAIN.
SO. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE - DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
-Plus-X$-=$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
SPARK ARRESTOR
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
n�
GdINSULATION/SOUND 'C? .��.
s
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
6LIND PLUMBING1/a(01
UNDERGROUND
A.C. UNIT
COLL. AREA
`SLAB GRADE L/OCL
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE'
FOUND. REINF.
✓ !
AS (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
INSP. —t� -
/t
.ROOFING /L/ /
'C✓ 115000 [ [ (
e7— RG,
OK 1—Q b."� �J I
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
n�
GdINSULATION/SOUND 'C? .��.
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL