10949 (AR)P.O. BOX 1504 No. 10949
Building77-978 La� o Drive ; LA Q
Address UINTA, CALIFORNIA 92253
Owner
Mr. & 2 _s. t.1,111liam Davila
Mailing ]BUILDING: TYPE CONST: OCC: GRP:
Address
City Zip Tel.
Yea QUinta 92253 ..
Contractor
7rS y
William H. Fkitz
Address . . "I
540-550 Ave"nidd Velasco
CityTel
La Qu3nta ]ZiP92253
.
64-6402
A.P. Number
Legal Description
Project Description Enclose Atrium & Add
Living Area
State Lic.
City
& Classif. $ 594854
Lic. # 1123
Sq. Ft.
No. No. Dw.
Arch., Engr., - • "
Sized •
Stories Units
Designer ''
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, anmy license is in full force
and
• •effect. V .., � t 1 t � � �Z _
'! _Sc:
SIGNATURE "'••m'•"- IA, DATE
' OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law,for the following
Estimated Valuation
rt 2 4
� �
reason: (Sec. 7031.5,Business and Professions Code: 'Any city or county which requires a
� '�'
permit to construct, alter, improve, demolish, or. repair any structure, prior to its issuance also
requires the applicant /or such permit to tide a signed statement that he is licensed pursuant to -
PERMIT
AMOUNT
the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) o/
-of
Division 3 the Business and Professions Code, �or that. heis exempt therefrom, and the basis
.for the alleged exemption. Any violation of -Section 7031.5 by 'any applicant for a permit
Plan Chk Dep.
subjects the applicant to a civil penalty o/ noUmore,than five hundred dollars.(8500). '
Plan Chk. Bal..
" 163 00
❑ 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 andCOnSt.
sJ 6 � -
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,
Mech.
t�
i.J. t%
provided that such improvements are not intended or offered /oi sale: If, however, the building
or improvement Is sold within one year of completion, the `owner -builder will have the burden
Electrical \
2 i. �!
o%proving that he did not build or improve for the purpose of sale.)_
N ` e•
a
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
slruct 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
S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
- � I am exempt under Sec. B. 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
Worker's Compensation Insurance, or a certified copy thereof. (Sec.. 3800, Labor Code.)
Policy No. Company
�RCopy 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.) -
I certify that in the performance of the 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% If, 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
I hereby affirm that there is a construction lending agency for the performance of the
work forwhich this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 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
�t4-� �t��i'a...•�.;� T il:,�.v . Er` �..�: ire , r..e ..'�'.
TOTAL •
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. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
I 1POWEROUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROCK STORAGE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
OTHER APPJEQUIP.
IKITCHEN 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
WATER SYSTEM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/. c
SEWAGE DISPOSAL
FINAL INSP.
SO.FT.GAR ® Vbc
HOUSE SEWER
ROOFING &b-glu `f
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBIN
<
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.
GAS (ROUG
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL 7
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING L
FINAL INSP. �/
[
ROOFING &b-glu `f
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
'mew
O
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION ( ��
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL