05504 (SFD)P.O. BOX 1504 No. 05504
ilding78-105 CALLE ESTADO
dress 48 -109 -Vista Ciele LA QUINTA„CALIFORNIA 92253 .
mer Abe& 'rf 2ma l3vassman
iling BUILDING: TYPE CONST. OCC: GRP.
dress 9010 Corbin Ave. S.3 A.P. Number 617--640-053
y Northridge lZip Tel. 9132
4. 818/3419-5894 Legal Description Lot, 33
ntractor
.. Jams C. Caen Project Description 3
77-200 Minnewta
City
Zip
Tel.:
. i Palms'Desert
92260
619/345-5430
-
State Lic.
City
&'Classif. $ 193333
Lic. # 260
Sq. Ft. 1552
No. No. Dw.
m
Size -
Stories - ' Units
Arch., Engr:,
Designer
New 0 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)r of Division 3 of the Business and Professions Code, and my license is in full force and
effect. fi
-' —
SIGNATURE-' X DATE
I OWNEWBUILDER DECLARATION
"Thereby affirm that) am exempt from the Contractor's License Law for the following
Estimated Valuation
-
$1020226.00,
reason: (Sec.. 7031.5,Busland ness aProfessions 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 file a signed statement that he is licensed pursuant to
PERMIT
AMOUNT
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
Plan Chk. Dep.
-
subjects the applicant to a civ9 penally of rrw more than five hundred dollars ($500).
Plan Chk. Bal.
545143
5.43
❑ I, as owner of the property, or my employees with wages as their sole�compensation, will
do the work, and thestructure is not intended or offered.for sale. (Sec. 7044, Buisness and
Const.
650.00
Professions Code: The Contractors 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.
66.50
provided that such brtprovemenls are not intended or offered for sale. If, however, the building
orImprovement is sold within one year of completion, the owner -builder will have the burden
Electrical,
111.72
of proving that he did not build of improve for the purpose of sale.)
.
❑ I, as owner of the property, am exclusively contracting with licensed contractors to coo-
Plumbing
144•.)u:
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.1.
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under SeG - B. 8 P.C. for this reason
i
Driveway Enc.
Date owner
Infrastructure
>w 733, 'Z�E'f3
WORKERS' COMPENSATION DECLARATION
1 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
1 O Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL,
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
—
._�..R'kr ,>',rr,�,a• rr ,z -s rc�,� r•i cy:
(This section need not be completed fl fine permit is for one hundred dollars ($100) valuation
A`4P+'...a'`4'iC@'7^'•"y°.Ja ram ��- rr.s.. ., :. -•-
or less.)
I I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
ZONE:
- BY:
subject to the Workers' Compensation provfgDft of the labor Code, you must forthwith
Comply with such proviwnsorOtis Permit Shall bedeemed revoked.
Minimum Setback Distances:
- I
Front Setback from Center Line
\ \- \-"N ' N •' a
Rear Setback from'Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which, this permit is issued. (Sec. 3097. CiOCode.)
•Side Setback from Property Line
lender's Name
Lender's Address
i This is a'building permit when property filled out, signed and validated, and is subject to
FINAL DATE
INSPECTOR
expiration it work thereunder is suspended for 180 days.
11� 0${3
;I certify that I have read this application and state that. the above information is correct.
Issued by:
Date 7 ! 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
a
r
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE ZQ
2ND FL SQ. FT.
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOB]LEHOME SVC.
BAR SINK
POR. gQ, FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEOUIP.
DRAINAGE PIPING
CAR P. I SQ. FT. ®
TEMP. POLE
WALL SQ. FT.
GROUT
DRINKING FOUNTAIN.
SERVICE
FINAL INSP.
URINAL
SQ FT ®
WATER SYSTEM
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
C
FRAMING X X
(/
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN r
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
INSULATION/SOUND 'j ( V
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
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 ZQ
OUGH 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
cu. yd.
$ -Plus-X$-=$
LUMBER GR(.�
FINAL INSP
C
FRAMING X X
(/
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND 'j ( V
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL