07711 (SFD)P.O. BOX 1504.. No. 0771.1 '
Building 78-105.CALLE ESTADO'
Address. ••. 30. is Sevilla LA QU"INTA, CALIFORNIA 92253
Owner .17J
Mailing
BUILDING: TYPE CONST., OCC: GRP.
Address.-
Atimicta p A.P. Number Y•
1'
CityZip Tel..
Legal Description
Tract 239n
Contractor , - v Project Description Phase l"A �6t 67
Address
• rt* � . . ,
City - Zip Tel.
State Lic. City
& Classrf Lic. #, Sq. Ft. 2100 R • -NO. No. Dw.
Arch. Engr.,
Size s Stories Units J
Designer= New ❑ Add ❑• Alter ❑ Repair.❑ Demolition
Address , Tel. r
City ' �y Zip State
Lic. #
-$• i .`., i ,; r LICENSED CONTRACTOR'.S•DECLARATION
hereby affirm that'l'am licensed under., provisions of Chapter 9 (commencing with Section
7000) of Diviston'3 of the Buslness.and Professions Code, and my license is in full/ iorce•and.
`effect. y'f=
rP.i s.�?'r .i'' ,••"4.`� "� �f. x�.., _ :.� �� r' off' : w�,� ,l P" _ - -
' >r' SIGNATURE - ``.,. '*"•r"''DATE _
OWNER -BUILDER DECLARATION Estimated Valuation
I' hereby ,affirm`that I'am°'exempt.from the Contractor's License Law for the following,
reason. r(Sec.70031:5:Business and. Professions Code: Any city or county Whichrequiresa -
permit to construct o after, improve, demolish,. or repair any structure, prior to its -issuance also AMOUNT -
requires the";applicant for such permit to file a signed statement that he is licensed. pursuant 'to PERMIT -
the prowsrons,of-ihe 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 :�s
'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 penally of not more than five hundred dollars (5500):
O I, as owner of the property, or my employees with wages as their sole compensation, will. Plan Chk. Bal.
do the work,;and the stiuclure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
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. - - 66 0
provided that* such. improvements 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 hot build or improve for the purpose of sale.) • ;
❑ I, as owner of'the property, am exclusively contracting with licensed contractors to con- Plumbing
struet 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 contractor(i) licensed pursuant to the Contractor's License Law.) _
Grading
❑ 1 am exempt under..'Sec. B:- & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure 2,518.16
WORKERS' COMPENSATION DECLARATION + `_
I. hereby'affirrii that'Ihave 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 - t
O Copy is filed.with the city. ❑ Certified copy is hereby furnished.
TOTAL 1 4,0`76,75'
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This sectionneed'not be completed if the permit is for one hundred dollars ($ 100) valuation �j"�-p"`�$`)+y�i'3s�''{' 4'A•''i�'IDY .'L3 •g
or less.) r
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 - Owner.
NOTICE TO' -APPLICANT:. If, after making this Certificate of Exemption you should become . ZONE: BY:
subject to the. Workers' Compensation provisions of the Labor Code, you' must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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
Lender's Name +
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE 'INSPgECTOR
expiration it work -thereunder is suspended for 180 days. 4�G61
1 certify that I have read 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 otapplicant Date
Mailing Address Validation:
City, State, Zip `
' ,.e ky -_'r r - w .r r _ --1. t i-. r. s c .��,., i rr e z .•si a S4 3 ,k ti�,ys ?y i •.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
A.C. UNIT
2ND FL. SO. FT.
SLAB GRADEt;F/GROUND
YARD SPKLR SYSTEM
UGH PLUMB.
MOBILEHOME SVC.
BAR SINK
FOR. SO. FT. ®
STORAGE TANK
FORMS
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORKROCK
STORAGEFOUND.
DRAINAGE PIPING
CAR P. SO. FT. ®
(ROUGH) n
<
METER LOOP
WALL SO. FT.
HEATING (FINAL)
DRINKING FOUNTAIN.
SO FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
GROUT
FLOOR DRAIN
MECHANICAL FEES
SERVICE
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
CU. yd.
$ -Plus-X$-=$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAa
6
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/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
PLUMB
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADEt;F/GROUND
UGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
WER ORS ROUGH WIRING
DUCT WORKROCK
STORAGEFOUND.
REINF('—S
/
(ROUGH) n
<
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ -Plus-X$-=$
LUMBER GR.
FINAa
6
FRAMING 7 Z
FINAL INSP. B q4
ROOFING At J !l(O /9 a �
/1
%)
l
Q � �
/
` ' 1 �d
e �
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR.
(�FII)REWALL
p IN�i
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S
SIGNATURESIINITIALS
GARDEN WALL FINAL