05934 (SFD)T,i`lt 4 4 Q"
o
Addrdess 78-725 Via 14P.10dia
Owner
Mailing'
Address 68--713 Perez 1W. 0 1
City Zip Te
Cat City 92234
Contractor
.sem
Address
City
'4
} State Lic.
AClassif.337,T7
Arch., Engr.,
Designer
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LAQUINTA, CALIFORNIA 92253
3-9024.,
Lic.# 1219,_ ., .,�
Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
'I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70pp) of Division 3/yf the BLusiness and Prof ns Code, and my license is in f ll fo_rc`ecannd
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,13usbress and Professions Code: Any city, or county which requires a
BUILDING: TYPECONST.
No. 45934
OCC: GRP. • ' -
A.P. Number.
Legal Description P$&3e ai Lot 19
Project Description Plan 180§ Pere T.6 Qulnta
Sq. Ft. -18(g, No. No. Dw. •
Size • Stories Units
Newl Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation 93,604.00
permit to construct, after, mgpiove, dennfsh, or repair any structure, prior to its issuance also
requires the applicant for such permit to tae a stgned statement that he is licensed pursuant to
-PERMIT •-
AMOUNT
the provisions of the Combaoror's Lbense Law, Chapter 9 (commencing with Section 7000) of
- a -
- Division 3 of the 11irskress and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption- Arty Section 7031.5 'any for
Plan Chk. pep.
violation of by applicant a permit
subjects the applicant to a civilpenally of not more than five hundred dollars ($500).
Plan Chk.. Bal.
- •
❑ 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
Const.
CM.5
Professions Code: The Contradars License Law does not apply to an owner of property who
-
builds or knproms thereon and who does such work himself or through his own employees,
Mech.
�� •
. provided that'.such krprovements are not intended or offered for sale. If, however, the building
- "
or improvement is sold within one year of completion, the owner -builder will have the burden
Electrical
of proving that he did not build or krprove for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to coo-
Plumbing
•�
struct the project (Sec. 7044, gess 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.
• .
such projects with a contractor(s) ficensed pursuant to the Contractor's License Law.)
•
Grading
❑ I am exempt under Sec- R. 8 P.C. for this reason
Driveway Enc.
Date owner
Infrastructure•��
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.
!• .`K �
TOTAL
.n.'t* .
CERTIFICATE OF EXEMPTION FROM
REMARKS
-,.:...>
WORKERS' COMPENSATION INSURANCE
^s ', r ^^ N
(This section need not be pe ( 1
orrmpleted tf the nrrit is for one hundred dollars 5700 valuation
cy^ r*�
t{ice Fait rlafd�r tr si#i{.� 51��` 43�.�•�}t�Y L
or less.)
I 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 Ownei '
NOTICE TO APPLICANT.` Il, after making this Certificate of Exemption you should become
ZONE:
BY: '
subject to the woikers' Compensation provisions of the Labor Code, you must forthwith .
comply with such provisions or this perms shall be deemed revoked.
Minimum Setback Distances:
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
Lenders Name
Lenders Address
FINAL DATE
INSPECTOR
This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for180 days.
6-16-89
I cer Illy that I have mad 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
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST 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
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
yd.
plus x$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP. IMcu.
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.
SO. FT. ® c
BATH TUB
FIRE ZONE ROOFING
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
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
SLAB GRADE �
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
yd.
plus x$
=$
LUMBER GR.
FINAL INSP. IMcu.
FRAMING Ad 94 AAA
FINAL INSP.
ROOFING v1
1
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
6�
LATHING '.Pk///l
MESH
INSULATIONISOUND D
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL