05836 (CONR)Building
' u
P.O. BOX 1504
78-105 CALLE ESTADO
LA OUINTA, CALIFORNIA 92253
Owner I
$UMERf DEVEWM
Address 777 S. MIYi2t ST., SUITE 106
City Zip rei7714-547-8056
ORANGE 92636
Contractor
Zip
State Lic.I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7lXXq of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8nrsiness and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demo&sh, or repair any structure, prior to its issuance also
requires the applicant for such permit to hle 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 vfofation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civi penally of not more than five hundred dollars ($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 Contractor's License Law does not apply to an owner of property who
builds or -reproves thereon and who does such work himself or through his own employees,
provided that such irprovoments are rpt 'intended or offered for sale. If, however, the building
or improvement is sok/ within one year of completion, the owner -builder will have the burden
of proving that he did not bold or improve for the purpose of sale.)
0 1, 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.)
0 1 am exempt under Sec B. & P.C. for this reason
r
Date 1 Owner
j r
WORKERS' COMPENSATION DECLARATION
WorkeI hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
rs 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
or less.) (This section need not be completedill the permit is for one hundred dollars (E100) valuation
1 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 i J
Date Owner +
NOTICE TO APPLICANT: 9, after mating this Certificate of Exemption you should become
subjectto 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
Lenders Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certity that 1 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
LDING: TYPE CONST:
Number 613-790-'016
Description
Loi 16
No. 05836
_OCC. GRP.
Project Description I'SAMMdl ME BU.
ZONE: BY:
Minimum Setback Distances:
w 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 5/31/89 Permit
Validated by:
Validati
Sq. Ft.
Size 924
No.
Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
21,806,40
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
]L •�
Mech.
+
Electrical
t)
Plumbing
31.0
S.M.I.
1.51
Grading
Driveway Enc.
•6
FUMETOM
l'i`il.7 E M
66.0
TOTAL
Lr100.03
REMARKS
ZONE: BY:
Minimum Setback Distances:
w 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 5/31/89 Permit
Validated by:
Validati
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO. FT. ® $
UNITS
SLAB GRADE
GH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT.
FORMS
SEWER OR SE I It
OUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SO. FT, ®
(ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
00GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN.
BOND BEAM
WATER SYSTEM
FINAL INSP.
URINAL
SO. FT. ®
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
VENTILATION
WATER PIPING
NOTE: Not to be used as property tax valuation
SPARK ARRESTOR
FLOOR DRAIN
MECHANICAL FEES
INSULATIONISOUND
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
t
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GARDEN WALL FINAL
LAUNDRY TRAY
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.
SQ. FT. ® c
BATH TUB '
SQ. FT. ® c
WATER HEATER -
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/e c .
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
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 R AIR COND. SOLAR
i
SETBACK
GROUND PLUM IN(:
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
GH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SE I It
OUGH WIRING.
DUCTWORK
ROCKSTORAGE
FOUND. REINF. 2�
(ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
00GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP. % '� / !D
GRADING
cu. yd.
$ plus x$
REMARKS:
=$
LUMBER GR.
FRAMING Idle?
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION'? — . L 50
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL