15088 (SFD)s
P.O. BOX 1504 N O . 15088
Building 78-495 CALLE TAMPICO
Address 47-990 Via Firenze LA QUINTA, CALIFORNIA 92253
Owner C8y T` $i0>Z2f:5 COLfttX2$f�SleB
a a. ,Z
Mailing
BUILDING: -TYPE CONST.. OCC: GRP. R3
Address 1535 South "D" Stxeet` 617-790- 09
A.P. Number
Sayn Be�'nard%no ZIpC-A 92.448 T
1(909*1361-6007 Legal Description Lot 9 `!'�c�C� 26152 Phase 1B
Contractor S�''� Pman 4G
Project Description
.Address Ppinnaker Care at Lake La. Qu$nta
IZip I Tel.:
State Lic.
City
& Classif.. - 31-4473
Lic. # 2120
Arch., Engr.,
Designer xank rponza.Ieri 4.
...
Associates
id.§As East Chapman Ave.
T11714) 332-6878
City
Orange; CA
Zip
926.66
State
Lic. #
�_ `LICENSED CONTRACTOR'S DECLARATION
1 herebyy affirm that I am licensed under provisions of`Chapter 9 (commencing with Section
7000) of Division 3 of the and Professions Code, and my license isrin full force and '
,Business
effect.,,
4 '-OWNEWBUILDER DECLARATION
I hereby affirm that 1 am exempt from the 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, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile 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 civil penalty of not more than rive hundred dollars ($500).
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 bu%ding
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.)
❑ 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 contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B.:B P.C. for this reason
I
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, 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'COMPENSATIONINSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certity.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 APPLICANT.- d, biter malting 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.. . .
'WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE.COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
This is a building permit when properly filled out,'signed and validated, and is subject to
expiration it work thereunder is suspended for•180`d'ays.
I per that I have read this application and,st to 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�l� i''r`�.�:^"�s s Date
'.Mailing Address
City, State, Zips
Sq. Ft.
Size 2741
New ❑ Add-❑
No.., No. Dw.
Stories Units
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $16,1 r 184 . 00
> PERMIT
Plan Chk. Dep.
Plan Chk. Bal.. \
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
Afts in. Public Places
TOTAL
AMOUNT
856.50 •
89. SO
y 2:-04:.
162.00-
16,12
20.00
.00
3,626.65-
152.96 626.65152.96
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. PLUMBIW\3 FEES
1ST FL. SO. FT. ® $
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
CARP. SO. FT.
ROCK STORAGE
DRAINAGE PIPING
WALL SO. FT.
AS (ROUGH) QJ
DRINKING FOUNTAIN
SO. FT. ®
OTHER APP.IEOUIP.
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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FRAMING
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/ic
HOUSE SEWER
GAR. FIREWALL
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 tj'
�<-
GROUND PLUM /
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE t� i�S�
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER R S C J
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
AS (ROUGH) QJ
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL.S
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-x$-=$
LUMBER GR.
FINAL INSP.A4/
FRAMING
FINAL INSP.
ROOFING
/
O/L�4z',;/"
�1
n//G-7/j•7
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL
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