05490 (SFD)P.O. BOX 1504 No. 05490
ilding 78-105 CALLE ESTADO
dress 68--137 Vista Clelo LA QUINTA. CALIFORNIA 92253
milli .. ,.
Abo & 'Thelm Ctassmit
Mailing:
Address 9010 Coibl Ave. 9:8
City Zip Tel.
"Zorthridge 91324, +8.16/?49-58g4
Contractor
1 $t8� C:.aEd
Address
77-200 1°ziSiievota.
City Zip Tel.:
# Palm; De."rt 92260 619/345-5
State Lic. City
& Classif. R 195333 Lic. # 2.60
Arch., Engr:,
Designer
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, and my license is in full force andv
effect. ! s a
{.iSK<.r_•' mow. d.�!'�?r. `J=am d•:'7..s.._...... ..!'
SIGNATURE - r' DATE'
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,13uslness• and Professions Code: Any city or county which requires a
Permit to construct, after. Improve, demolsh, 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
the proviskms of the Contractors 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 exernplion. Any vknWan of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penally -of not more than five hundred dollars (8500).
❑ 1, 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 Contractoes 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 that such improvements are not Intended or offered for sale. If, however, the building
or improvement is said within one year of completion, the owner -builder will have the burden
of proving that he did not build 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 conbactohs) licensed pursuant to the Contractor's License Law.)
• t
❑ 1 am exempt under Sec B. & P.C. for this reason
t
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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
(0 Copy is filed with the city. ❑ Certified copy is hereby furnished.
fCERTIFICATE OF EXEMPTION FROM '
WORKERS' COMPENSATION INSURANCE
(rhos section need not be conpleted O the pemrit is for one hundred dollars ($100) valuation
or less.)
:I certify that in the performance of lhp 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
NOTICE TO APPLICANT: O, after making Nis Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or Oris Permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY.
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,) '
Lenders Name
Lender's Address
This is a building permit when property filled out, signed and validated, and is'subject to
expiration if work thereunder is suspended for 160 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
I
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 617-640-039
T.OLegal Description 39
Project Description
Sq. Ft. 1852, No. No. Dw.
Size- Stories - Units
New.1B Add ❑ Alter ❑ Repair ❑ -Demolition ❑
Itimated Valuatior
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
$102t.226.00
AMOUNT
Electrical
111#1Z
Plumbing
Ni F -5U
S:M.I.
Grading
Driveway Enc.
Infrastructure
FINAL DATE
INSPECTOR
3/14,r 07
Issued by:
\ -A
Validated by:
4 • '
TOTAL
Validation:__
REMARKS
s s r.r:..
'
;i': +,.r x .s f}` •.w '�'1 'f r51c:N {',.• r s:.i'f'IVA _et
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
3/14,r 07
Issued by:
Date Permit
Validated by:
Validation:__
CONSTRUCTION ESTIMATE
NO. .,ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SD. FT.
Lwor
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
DRAINAGE PIPING
CAR P. SO. FT.
AS (ROUGH) `i l '
`METER LOOP
WALL SO. FT.
HEATING (FINAL)
DRINKING FOUNTAIN.
SO. FT. ®
GAS (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER HEATER
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
cu. yd.
$ -Plus-X$-=$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
/ FINAL INSP/ -
LAUNDRY TRAY
AIR HANDLING UNIT CFM
ROOFING S t/
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.
SO. FT. ®c
BATH TUB
FIREPLACE
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Ac
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 I CTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING rW
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
Lwor
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. (/j sem/
AS (ROUGH) `i l '
`METER LOOP
HEATING (FINAL)
OTHER APPIEOUIP.
REINF. STEEL
GAS (FINAL)
f TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
AAA
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
/ FINAL INSP/ -
FRAMING7
FINAL INSP.
ROOFING S t/
r ,
9
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWAL r
LATHING
MESH .dpi
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
`
GARDEN WALL FINAL:d
(