002191 (SATT)P.O. BOX 1504 No, 002191
Building78-105 80-393 le � LA QUINTAC
Address CALIFORNIA 92253
Owner _
Sunrim BUILDING -
TYPE CONST. OCC: GRP.
Mailing
Address 75-005 Club Dr. A.P. Number
City Zip Tel.
Palm rt 92-260 568-2W _ Legal Description
ContractorNatl Hi=tge- and Land Project Description ECA V= AMM,2 $
- Address ..
Plan 10 0
City' Zip " Tela
$fid
State Lia City
& Classif... 2 .3o Lic. # 32 Sq. Ft. �p No. No. Dw.
2272
Arch.; Engr., -
Size' G?Jt 582. • Stories I Units 1
Designer New.0-+ Add ❑ Alter ❑, Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S. DECLARATION _
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.. y .l.. r * ?
� fy
SIGNATUREY !" - DATE - -
`�; OWNER -BUILDER DECLARATION
I hereby affirm that I am ESIIfTlated Valuation exempt from the Contractor's License Law for the following -44#517.00-
reason: (Sec. 7031.5,Business and Professions Coder Any city or county which requires a '
-'permit to the applicant for such permit construct, alter, improve, demolish, or repair any structure, prior,to its issuance also AMOUNT
requires 'lo file a signed statement that he is licensed pursuant to 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 We civil penalty of not more than five hundred dollars ($500).-
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 4612.89
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. �
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
55.00
or improvement is sold within one year of completion, the owner -builder will have. the burden Electrical -
of proving that he did not build or improve for the purpose of sale.) .. 102.17
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing in .sRD
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law �2
does not apply to an owner of property who builds or -improves thereon, and who contracts for S.M.I. - - 9.84
-such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I. am exempt under Sec. B. 8 P.C. for this reason Grading
Driveway Enc.
Date owner Infrastructure 2,000.00
WORKERS' COMPENSATION DECLARATION
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
O Copy is filed with the city. . ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'. COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.) - -
1 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' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of 'Exemption you should become
subject to the Workers' Compensation provisions of "the' Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's Address
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.
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+1 A Date r <.
Mailing Address i
City, State, Zip
HARD COPY
TOTAL
REMARKS
ViCa. M SPA WT PM M TM PM=
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
Issued by:
Date Permit
Validated by:
Validation:
A4834
3 18 331:5,90 CK
CONSTRUCTION ESTIMATE Adik
NO. ELECTRICAL EF^"
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
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 APPJEQUIP.
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
inare�, i vn a ananH � vnc�m� i �Nw
GARDEN WALL FINAL