002560 (RPL)' .•4 RIM&
P.O. BOX 1504 N o. 002560
Building OCAddress 55-405 Pebble LA QUINTACALIFORNIA 92253
'
Ownersumiall
_..
BUILDING: TYPE CONST.00G:.GR
Mailing P.
� � '
Address7�-79-
75-005 �3�1t�'�i7 �fJ� '+iY.'. A.P. Number ..
City Zip Tel.
Legal Description 13
A&IM92260 8-8
Contractor
. _. 1016 .'FL
� , . .. Project Description "--�-- -
Address.
68-4165 PeXez
City Zip Tel.
tit. city 92236 328- 681 .
State Lic, City
& Classif. 27579 Lic. # 69 Sq. Ft. No. No. Dw.
:; Engr., . .. _
Size Stories Units
Arch
Designer New 0gt Add ❑ Alter ❑. ' Repair ❑ Demolition ❑
Address Tel.
City Zip State 15 'X 23 pool .arid 7. x 7
Lic. # .
LICENSED CONTRACTOR'SDECLARATION
I hereby'affirm that Lam licensed under.provisions•of_Chapterg.(commencing with Section
7000) of Division 3 of%the Busmess,and Professions Code, -and my license is in fulisforce and
• . effect, fi f,yy , -- _.. .-•
SIGNATURE DATE ,, ," _ _ • „ .
OWNER -BUILDER DECLARATION Estimated Valuation
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 :20.060-0.0
permit to construct; after, improve, demolish, or repair any .structure, prior- to its issuance also - AMOUNT
requires the applicant for such permit to file a signed'statement that he is licensed pursuantto:.PERMIT - .
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 acivil penalty of not more than five hundred dollars ($500). - Plan ChkBBI•22
O I, as owner of the property,. or. my employees with wages as their.sole compensation, will . . . y
.
do the work, and the structure is not Intended or offered for sale. (Sec. 7044, Buisness and Const.. d
Professions Code: The Contractor's License Law does not apply to an owner of property who
50
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 16.40
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical '20.00
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. Plumbing 14.00 -
struct the project. (Seca 7044, Business and Professions Code:- The Contractor's License Law _. _ �a
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. - - it4
• such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
O I am exempt .under .Sec. B. 8 P.C. for this reason Grading
Driveway Enc.
Date owner Infrastructure
WORKERS' COMPENSATION DECLARATION
'.l hereby affirm that I have a certificate of consent to self -insure, of 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.
TOTAL 293.3b
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, I shall not
-
employ any person in any manner so as to become subject to the Workers" Compensat!on
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 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 affiim 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
Lender's 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
`4�
certify that I have read this application and state that the above information is correct.
'with
issued by:
7" 4��� Permit
Date 7
I agree to comply 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 purpose)
Signature licant���
Validated by:
of app
Mailing Address ?
Validation:
City, State, Zip
A63.08
9 1,0 9316 U
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST 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 SQ. FT. @
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER HEATER
SERVICE
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
GRADING
CU. yd.
$ -Plus-X$-=$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
GAR. FIREWALL
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
MESH
SQ.FT.GAR ® 3/ac
HOUSE SEWER
INSULATIONISOUND
GAS PIPING
PERMIT FEE
FINISH GRADING
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 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.
FRAMING
FINAL INSP.
ROOFING
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL