07262 (SFD)Buildin
Address 78-280 Via Sevilla
Owner
Deane Hows
Mailin
Address 15 .Agusta
City Zip
Rancho th r, ge 92271
Contractor
. . . Ume
P.O. BOX 1504 No. 07262
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Tel.
SSE -2828
Tel.:
State Lic. I City
& Classif. 50920 Lic. #
Arch., Engr.; -
Designer
Address Tel.
City(Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereb affirm that I am licensed under„prosions of Chapter 9 cemmenci
ap ( ng with Section
7(100) of 4ision•3 of the Bu sinessand-Professions Code, and my license is in fu 1 f and
effect:��'�i
_SIGNATURE P DATE
9
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,13usiness 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 Ole a signed statement .that hes licensed pursuant to
the provisionsof the Contractor's License Law, Chapter 9 (commencing with Sector 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 'arty applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred donars ($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, Busness 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 empAoyees,
Provided that such improvements are not intended or offered for safe. It, however, the building
or improvement is bu
sold within one year of completion, the owner@der wig have the burden
of proving that he did not build or improve for the purpose of safe.)
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-Contractoes License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
C such projects with a contcactor(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
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O 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 deRus ($100) vadraton
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
NOTICETO APPLICANT." N, after making this Certificate or 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.for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's 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 certity 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
11LDING: TYPE CONST. OCC: GRP.
P. Number 03•`402-004. 009s 014
,gal Description Tent.. TP. No. 23971
oject Description, Phase I — A
Lot 10-
Sq.
Q
ZONE:
BY:
Minimum Setback
Estimated Valuation
U71,250
Front Setback from Center Line
PERMIT
AMOUNT
Sq. Ft.
Size
3350
'.No. 2
Stories
No. Dw.
Units
New ❑
Add ❑
Alter ❑
Repair ❑ -Demolition ❑
• :50
Validated by:
Mech.
Validation:
Electrical%
Plumbing
130 50
_
S.M.I.
ZONE:
BY:
Minimum Setback
Estimated Valuation
U71,250
Front Setback from Center Line
PERMIT
AMOUNT
Plan Chk. Dep.
pGaa
Side Setback from Property Line
Plan Chk. Bal.
FINAL DATE
INSPTC�TO
Const.
• :50
Validated by:
Mech.
Validation:
Electrical%
Plumbing
130 50
_
S.M.I.
[•!}rt
Grading
Driveway Enc.
Infrastructure
asv�as`
TOTAL
sv .ries x) xl
`
REMARKS
t..Rr .� �., .n �-s•.r e:n •�n .z.:s
tri
r--ry tW._, r
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
INSPTC�TO
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE -�
YARD SPKLR SYSTEM
2ND FL SO. FT. ®
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
ROUGH WIRING.
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
GAS (ROUGH) Q SC ��
t
METER LOOP
DRAINAGE PIPING
CAR P. SO. FT. ®
REINF. STEEL
GAS (FINAL)
TEMP. POLE
DRINKING FOUNTAIN.
WALL SO. FT.
GROUT
WATER HEATER
SERVICE
URINAL
SQ FT ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
$
FLOOR DRAIN
MECHANICAL FEES
LUMBER GR.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROOFING kI ?1L� �6 4J?rw7Ct
/y
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Ac
HOUSE SEWER
MESH
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
S ER OR SE
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) Q SC ��
t
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
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. &DA6a 4D
FRAMING '%C(0 o t -P
FINAL INSPI Gl/
ROOFING kI ?1L� �6 4J?rw7Ct
/y
�� y/� L/ % �/a
jO P ®�—r
X/-/
G
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
HING ?17,61% t -Q
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION�� OZ
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL