11040 (AR)f
4
P.O. BOX 1504 N o . 11040
Building 78-105 CALLE ESTADO r.
Address 49-475 Vista Bonita LA QUINTA, CALIFORNIA 92253
Owner y
Mr/Mrs Bastacin ,
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address Same
A.P. Number
City Zip Tel.
Lig. Quinta 92253 Legal Description
Contractor Project Description
G.L. SCrivens Const_-. Room At: di -tion
Address
260 Pinyon Crest
City Zip Tel.:
Mtn Center 92361 349-3327
State Lic. City
& Classif. B 521353 Lic. #r U l� Sq. Ft. ' No. No. Dw.
t Size 1:35 Stories Units
Arch., Engr.,
Designer New ❑ 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) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATLRE DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the followingg v
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 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. 76.05
1 �t C
subjects the applicant to a civil penalty or not more than five hundred dollars ($500). Plan. Chk. BBI. ! 6 . V .5!
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 1 . i Q
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or Improves thereon and who does such work himself or through his own employees, Mech.
provided that'such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical 19. �$
of proving that he did not build or improve for the purpose of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con, Plumbing
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 S.M.I. .70
such projects with a contractor(s) licensedpursuantto the Contractor's License Law.)
Grading
O I am exempt under Sec. B. 8 P.C. for this reason
11 Driveway Enc.
Date ' "Y"I 1 4Owner ` j t'' r �' ! t-•' Infrastructure
V "
WORKERS' COMPENSATION DECLARATION
'1 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 ! j f ia'S ii1 Ci d
Copy is filed with the city. ❑ Certified copy is hereby furnished. i FF T l 41 ' 2i 3. 47
TOTAL 213.47
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE .
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, 1 shall not
=any pperson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT. 1t', after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances:
Front Setback from Center.Line
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, Civil Code.) Side Setback from Property Line
Lender's Name
Lenders Address FINAL DATE INSPECTOR
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 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 of applicant— Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CARP. SQ. FT.
WALL SQ. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ic
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEEPLUMB. 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
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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.? ` L
FRAMING
FINAL INSP.
9
ROOFING
/ /�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
HING. 2�j ;L�-J%
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTIO q L
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
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C-OVE
'R `HIT ECTURAL/ LAINDSCAPE VARA: 16:\ I !., --
:r Avenida '-v-:sta Bonita
a .,Ce a , pa le Ta, -:Ta --r, be:-�:— apprc,,--c-
7
T. E. C,
Cid". te S ut (Ll w i r; C;
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A 1 w c) r i -1 si.a 1 be done i n a w -D;-!,man -1 e *-*-! a nn'ii! r by C 0 M et, e n
and licensed professionals.
". Actual modifications must conform to the olans a -,-.d
spec--f--cat-iors submitted a;; -,d approved.
-.:l worl".. is t� ice n cor..,:pi'lan-ce wit'n COCES an
or -. n,arces.
4. Any da..mage to the common areas res,-.-1t,.rq frorr, this
arc its Const r---ction will :;e repairec at
e.x L) e!'i s e
C t a C., t -t S t ru Cp e t r- :D;,. p r o (2 a, s,
e A ss c. c -a 4
pr is:- tD the commencelient of a;-ly
Z, 7-
f
d s t gate
CA a C con', n; n
t) E: c. :,_j r
e Lz, p o: is ano -r-hat of subsequent owners
:-,
exe�-�uite a 1%,jj- 1 T a,C a
e aL t 4- C.
a 9 r E;E; S da t i On
LL
L n - ID e r r.t t. . s s e J by t.fiet a u r Wit. m -j s e
ar; ci E. -i L) y Id s:..-; 1, a v e -: on the C -f your i-,o:*rie at
-S d L e c s t C t c : i o f IL hi�, mca - F IC-ton: -a
r;- + i s -�D bE en t�) F.-jc:,�. tO
e L at o
T any wz- i.. and a c --*. p y of ed off erm I t
C m p i et io:,.
e e, r u e r um a n. d n c ri.
-F a - e a
-s is t3 be removed f rom he r ocf a: -ea =--,nd
a c3m.p ;e,lion of construction.
A; i nnst-uc-,iori debris is to be r-E�t,,oiedl fr-:m t'r-;e S i to
.-,,ee',end in order to
-a d r, e t a t- I e
i .:eve ipmenL.
e e, c t- c a I r- i r i te
c:. -'i d u i P a i t t e d .3 -a t C I the e s u -F i c r t
Y ;_, I I b e r e q Lj i r a o ..al, - ;i t a ri;:- w r:�C. f a r i� a .
or appear a,, c:= t c be as -:- h --)w i o!,, a t-* t- Etc -, e J' 1raw.: -::D 1 e
as present, sof i ts- Qild s 1, i d I n a.; s r e4
10. You are reqjire-d tl-o relocate ':'lose bib,
exterior light fixtures.
11 . Approva letter f cell c- ri; ! o - i W.31 neighbor, Don Curl -is L."
obtained and presented to Association.
12. You must preserve the vent for tne attic space.
a o'a c - -s e A o c a t- c.:,.
t._.r,.,,
:-e-'-d u,.1 agree -.o ab': L.y -e .iis e
a a;-, J s, � a ' p E, v -a r a!; C; c; ,assoc, a P P r, -ova a e
e�lse ri
anreturn copy i a .-i o: o e
;
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