06314 (SFD)(:c4tit 4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Artrlrpcc 48-251 Calle Floristas LA QUINTA, CALIFORNIA 92253
Owner
AMOUNT
Plan Chk. Dep.
Abe 6 ihelm Crow=kn
Mailing
Address
9010 Corbin Ave.,
S-3
City
66.50
Zip
111.72
Tel.
Northridp
91324
7.21
$
Contractor
Driveway Enc.
- _ , s A-, r- .
Infrastructure
James�
Address
i y ,.z
.� tt
$311825.45
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State Lic..�
& Classif.
14 y L
ISIM33�' ;r
City j ' - (, t
Lic. # 2.. Q0
Arch., Engr.,
Designer
Address
Tel.
City IZip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
70D0) 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 affirin that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8msiness and Professions Code: Any city or county which requires a
permit to construct, alter, irpmve, 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 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
subjects the applicant to a avi penally of not more than five hundred dollars ($500).
❑ 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 rmWovements are not intended or offered for sale. 8, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
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-
struct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who bunds or improves thereon, and who contracts for
such projects with a contractor(s) icensed 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 1 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.
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.)
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.
Date Owner
NOTICE TO APPLICANT: 8, 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
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.)
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 160 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
No.
11LDING: TYPE CONST. OCC. GRP.:
P. Number 617-652-026
06314
Description
t Description Tract 20052-2, Plain 3, Lot 26
Sq. Ft. 1980 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$ 545.43
Const.
650.00
Mech.
66.50
Electrical
111.72
Plumbing
144.50
S.M.I.
7.21
Grading
Driveway Enc.
Infrastructure
2,300.09
TOTAL
$311825.45
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 9/19/89Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
STRt1CT1IRF PI IIMRINf FI FCTRICAI HFATING A AIR CONII SOI AR
SETBACK GROUND PLUMBI UNDERGROUND A.C. UNIT COLL. AREA
�
PPP"`�,20—ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK
LAB GRADE
j
FORMS ER OR SE TA ROUGH WIRING DUCT WORK ROCK STORAGE
FOUND. REINF. G S (ROUGH) METER LOOP HEATING (FINAL) OTHER APPIEOUIP.
REINF. STEEL GAS (FINAL) .� TEMP. POLE
GROUT WATER HEATER SERVICE FINAL INSP.
BOND BEAM WATER SYSTEM
GRADING
LUMBER GR. �yAL INSP3. cu. yd.
�
RAMING FINAL INSP. $ plus x$ _$
OOFING _ REMARKS:
1,2
Al
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
JkATHING
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SO. FT. ® $
UNITS
YARD SPKLR SYSTEM
2ND FL SQ. FT.
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
CAR P. SO. FT.
WALL SQ. FT.
DRINKING FOUNTAIN
URINAL
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
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
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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.
SQ. FT. ®c
BATH TUB
SQ. FT. ®c
WATER HEATER
MAHEATER OUTPUT, B.T.U.
X.
SQ. FT. RESID ®1+/. c
SEWAGE DISPOSAL
SQ.FT.GAR ®Nic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
ERMIT F
PEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
MESH
SULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL