07267 (SFD)Buildin
.ng 78-380 Via Sevilla
Tull
Owner
Titif 4 4 a"
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Deane Homes
Mailing
Address 15 Agusta
City Zip Tel.
.. . Rancho Ki r tge 92270 558-22828•
Contractor
ress
City lZip
State Lic. I City
& Classif. 509208 Lic. #
Arch., Engr.,
Designer
Address' Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby of /Frm that I am licensed under provisions otChapter 9 (commencing with Section
7000) of Division 3 of the Business and�fessfons CAgde, and my lic�Ae ils;�t ill loo a
effect (�'L.1Jl/1 5l
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,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 five hundred dollars (5500).
❑ 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 Nat such improvements are not intended or offered for sale. If, however, .the building
• or improvement is sold wifhh7 one year of completion, the owner -builder will have the burden
of proving that he did not bund 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 contractor(s) licensed pursuant to the Contractor's License Law.)
0,1 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' COMPENSATION INSURANCE
(This section need not be completed /f 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 sous to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: ft, 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
Ihereby affimi 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
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 100 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
No. 07267
BUILDING: TYPE CONST: OCC: GRP.-
A.P. Number 613-402-004, 009: 010
Legal Description Tent. Tr. No. 23931
Project Description Phan e I — A
Let .
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
2128/90
.Issued by: Date Permit
Validated by:
Validation:
Sq. Ft- 33
Size
No.
-Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$171,250
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
59
Const.
50
Mech.
. 60
Electrical
103,6Z
Plumbing
150.50
S.M.I.
12.04
Grading
Driveway Enc.
Infrastructure
3st3sJ3� 13
.y
,'t r
TOTAL
sliiti
��' �1
REMARKS
A'
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
2128/90
.Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
P:O. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE Q/
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING,
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH) Vlaho C r,
METER LOOP
HEATING (FINAL)
I 1POWEROUTLET
ROOF DRAINS
GAR. SQ. FT. @
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SQ. Ff.
=$
LUMBER GR.
FRAMING 21
URINAL
SOFT ®
a/ZfD
ESTIMATED CONSTRUCTION VALUATION $
REMARKS:®
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
I
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SPARK ARRESTOR
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAR. FIREWALL
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.
SQ. FT. ® c
BATH TUB
FINISH GRADING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® IV. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3'ic
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
ROUND PLUMBIN !
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE Q/
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING,
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) Vlaho C r,
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
EINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP. t'f7 O
GRADING
Ql $ cu. yd.
plus x$
=$
LUMBER GR.
FRAMING 21
FINAL INSP.
ROOFING '
a/ZfD
REMARKS:®
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
TING U C G
MESH
INSULATIONISOUND
a�
FINISH GRADING
FINAL INSPECTION
i
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL