15623 (RR)P.O. BOX 1504
Building 4954.0/550/574/5 D Vi,s�,a 78-495 CALLE TAMPICO
Address OBi�t46A QUINTA, CALIFORNIA 92253
Owner_� '' • ^
�a>tta Rosa Cave HOA
Mailing
Address 50-10"1 � elle. Oaxaca
City Zip°? 'j Tel.
La Qui it 9�2�3
Contractor
tr ant Universal
' Address
Gity Zip - Tel.:
,a: 'spr ngs 92260 320-6021
State LIc r City
' & Classlf .'3f53.5.7 Lic. # 2293
Arch. Engr., f
Designer
-t
Address Tel.
-t
Cityi ,: Zip State
.� Lic. #
LICENSED CONTRACTOR'S DECL\RATION
I hereby affirm that I am licensedunder provisions of ChWter 9 (commencing, with Section
700e0)off Divi Ion 3 of the Business and. Professions Code, end my license is in full force and
eff�LGNATURE - - - DATE
'OWNER -BUILDER DECLARATION '
I hereby affirrn.that I am exempt from the Contractor 3 License Law for the following
reason: (Sec. 7031:5,Business and Professions Code: Any city or county whichrequires a
permit ro construct, atter, improve, demolish, or repair any s-ruclure, poor to its issuance also
requires the applicant for such permit to File 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 k 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 hund•ed dollars (8500).
- •O 1, as owner of the property, or my employees with wageE as their sole compensation, will
do the work, and the structure is not Intended or offered tor sale. (Sec. 7044, Buisness and
Professions Code:._The Contractor's License Law does not apply to. an owner,ofproperty who
builds or improves "thereon and who does such work himsel or through his own employees,
provided that such improvements are not Intended or offered' for sale. -If, however„the building
- orimprovement is sold.wtthin one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of saleJ
❑'I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and .Professions Gide:. The Contractor's License Law
does not apply to an owner of propertywhobuilds or impro -es thereon, and who contracts for
such projects with a contractor(s) pcensed pursuant to the Contractor's License Law.) -
f] 1 am exempt -under Sec. B. 8 P.C. for this reason
Date Owner
WORKERS' COMPENSATION OECLARATION
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 the eof. (Sec. 3800, Labor Code.)
Po icy No. ° !3 ice..- •. Company I'%N6Es» a
. Copy is filed with the city; . O Certified copy is.heeby furnished..
N o..-.1 62 Y .
:.r.
11LDING> TYPE CONST..- OCC: GRP.
P. Number
gal Description ~' f'' •'4
oject Description 'te-"robs existing built -UP r
.
with polgur ethanb foam and coating.
Sq. Ft. y;No No. Dw
Size ,•.Stories '• Units
New ❑
Add.❑ `-Alter ❑
Estimated valuation =
'REMARKS
PERMIT
,
Plan Chk. Dep.
Plan Chk: Bal. '
Const.
I certify that in the performance of the work for which this permit is issued, I shall not
Mech.
Electrical
Plumbing
S.M.I,
Grading
Driveway Enc.
Infrastructure
TOTAL T.
7
Repair ❑ Demolition ❑
T,
CERTIFICATE OF EXEMPTION FROM
'REMARKS
•WORKERS' COMPENSATION INSURANCE.
(This section need not be completed if the permit is for oae 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 parson in any manner so as to become subject to the Workers' Compensation'
Laws of California
Date Owner
NOTICE TO APPLICANT: It'aRer, making this 'Certificate -of'Exemption you. should become -
ZONE:
- BY: '
subject' io the Workers' Cornpensauon provisions of .the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:
- - v
Front Setback from Center Line
Rear Setback from Rear Prop:'Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL; AND
'SHALL
Side Street Setback from Center Line
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
. HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION -O.THE COST OF -COMPENSATION,
Side Setback from Property Line
DAMAGES AS PROVIDED FOR IN SECTION 37D6 OF TFE LABOR;CODE, INTEREST,'AND
f
ATTORNEY'S FEES.
T his is a buildingFINAL
permit when properly filled out, signed. and validated, and is subject to
DATE
INSPECTOR
r
expiration if work thereunder is suspended for 180, days. -
I that I -have
t
certify read.this application and.state that the. above information is'correct.
I
Issued by:'
jFDatt Permit
agree to comply with all city and county ordinances and state laws relating to building
construction, hereby -this
and authorize representatives, -of city to enter the above-..
mentioned property for Inspection purposes-
Validated by:
f r'' Z• 1 ]
Signature of applicant. iDates '
Mailing Address
Validation:
City, State, Zip
E... f
r Vii! - ._
' ' ' �:•' F..(. -J ;' ., - ,� ..r
..
,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APP./EOUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
GAR. FIREWALL
SO.FT.GAR ® 3/ic
HOUSE SEWER
LATHING
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
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./EOUIP.
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.
FRAMING
FINAL INSP.
ROOFING p ��
O 7
•
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
\ SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL 71