07268Building
Address 44-5 5 Via Dei flonte
Owner
Deane Huns
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address 15 Agusta
City lZip, Tel.
Rancho Mir 9e 92270 66$_21328
Contractor
ress . .
el.:
State Lic. I City
& Classif. $03208 Lic. #
Arch., Engr.,
Designer
Address' Tel.
City(Zip I
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION '
hereb affirm that I am licensed under p�gvisions of Chapter.9 (commencing with Section
7000) of rvision 3 of the Bu@Y Professions Code, and my Ifcens` h m f 11 f rrce and
effects \!\ � 4 in 7
�GNATLRE DATE
OWNER -BUILDER DECLARATION
I hereby affir7n that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Busimess and Professions Coder Any city or county which requires a
permit to construct, after, improve, demofish'or repair any structure, prior to Its issuance also,
th
requires e applicant for such pemilt to file a signed statement that he .is gcensed pursuant to
the Provsbrhs of the contractors License Law, Chapter 9 (commencing with Section 7000) of
` Division 3 of the Business and Professions Code, or that. he is exempt. therelmm. and the basis
for the alleged eiremption Any violation of Section 7031.5 by any applicant for a permit
subjects the appgtarnt to a civil pernafTy of not more than rive hundred dollars ($500).
❑ 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, Bufsness and
Professkms Codej7he CoriftWor'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 &Wfovements are not Intended or offered. for sale. If, however, the building
or improdement is sold within one year of completion, the owner -budder wig have the burden
of proving Ihat he did not build or in prove for the purpose of sale.)
01, as owner of the property, am exclusively contracting with licensed contractors to con-
itrUct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not appy 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
Workers 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) vahration
or less.). - -
I certify that in the performance of thg 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 APPLfCAW. 0; 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 pvovsions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 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.) .
Lenders Name
Lenders Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180.days.
I certify that I have read this application and slate 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. 072,68 -
BUILDING: TYPE CONST. _OCC: GRP.
A.P. Number
Legal Description
Project Description
6113-402+-004,.
Tett. Tr. tio.
PhAse i A
Lot 8 a .
009, 010
23971
Sq. Ft.3360
Size,
No. 2
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑ '
Estimated Valuation
$171,2 50
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
x.59
Const.
891-
Mech.
66.50
Electrical
163.62'
Plumbing
150.50
S.M.I.
142. 34
Grading
Driveway Enc.
Infrastructure
3:$53.13
i f
TOTAL
REMARKS
1}Etr4}'r.2•tit.?t.":k
!lta-!#. _ #L;
taxa
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:
r
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
flAVSLAB GRADES
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2N0 FL. SQ. FT.
FORMS
EWER OR SA
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH) qkL,6
, METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SQ. FT. ®
GROUT
WATER HEATER
WALL SO. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SQ. FT. ®
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FRAMING$
WATER PIPING
NOTE: Not to be used as property tax valuation
pr t v /4/0
(a CFA__
FLOOR DRAIN
MECHANICAL FEES
REMARKS:
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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
MESH
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® IVi c
SEWAGE DISPOSAL
FINISH GRADING
SQ.FT.GAR ® Vic
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
flAVSLAB GRADES
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR SA
ROUGH WIRING
DUCT WORK
ROCK STORAGE
I
FOUND. REINF. �`/
v
GAS (ROUGH) qkL,6
, METER LOOP
HEATING (FINAL)
OTHER APPIEQUIP.
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. -/ 5g7d 0.
FRAMING$
FINAL INSP. Q
l�
ROOFING A / Z�da✓Qd
pr t v /4/0
(a CFA__
?/ 3/40
$ If3 //ll
C 6 L
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
HING
MESH
INSULATION/SOUND to Q
66661111
FINISH GRADING
FINAL INSPECTION
—144
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
'
GARDEN WALL FINAL
k