04633 (SFD) 111111311 08404683
IE
P.O. BOX 1504
Building78-105 CALLE ESTADO
Address 79-801 Arnold Palmer LA QUINTA,CALIFORNIA 92253
Owner cook. aer1 f// BUILDING: TYPE CONST. OCC.GRP.
Mailing
Address 1855 Es Valley fter%may A.P. Number - - wtA WAR#-
City Zip Tel.
Escondido 92027 747—$900 Legal Description
ContractorProject Description Block wall
Some
Address
City Zip Tel.
State Lic. 462446 City .2m, f
8 Classif. Lic.# ! Sq:Ft. - - No. No. Dw.
Arch., Engr.,
Size Stories Units
Designer New ❑ Add ❑ Alter❑ Repair❑ Demolition ❑
Address Tel. '
City Zip State
Lic.#
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under Provislons,of Chapter 9(commencing with Section
7000)of Division 3 ofpjlhe Business and Professions Code,and my license is in full force and
effect !
SIGNATURE -R ,K•* DATE
OWNER-BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractors License Law for the following
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 AMOUNT
requires the applicant for such permit to 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 to a civil penalty of not more than five hundred dollars($500).
0 1,as owner of the property,or my employees with wages as their sole compensation,will Plan Chk. Bal.
do the work,and the structure is not intended or offered for sale.(Sec. 7044,Buisness and
^
Professions Code: The Contractor's License Law does not apply to an owner or property who Const. 312 0.00
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
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
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.1.
such projects with a contractor(s)licensed pursuant to the Contractor's License Law.)
Grading
O I am exempt under Sec. B.&P.C.for this reason "
Driveway Enc.
Date Owner Infrastructure
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
❑Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL -'zo c),,
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATION INSURANCE 0(
(This(This section need not be completed if the permit is for one hundred dollars ($100) valuation �# �i• i.Yi7' Jt•� `.t{ Y Y ���u t}. V�t3
or less.)
r I certify that in the performance of the work for which this permit is issued,I shall not
{ employ any niperson in any manner so as to become subject to the Workers'Compensation
Laws of Call fora.
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 Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
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
Lender's Address FINAL DATE -INSPECTOR
This is a building permit when properly filled out,signed and validatedand Is subject to
,
expiration if work thereunder is suspended for 180 days. 10/17/8Q
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
WHITE-FINANCE,PINK.-APPLICANT,GREEN-BUILDING,GOLDENROD-ASSESSOR'S OFFICE,HARD COPY-FILE
. . .. ....., ._.•-•,.,,�. . . .,.. Vit.. .. -.. - _. . , ,.. - , ._.
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
ISI FL SO F1 rp $ UNITS
2ND FL SO FT.R YARD SPKLR SYSTEM
POR SO FTa MOBILEHOME SVC. BAR SINK
GAR SO.FT.kr POWER OUTLET ROOF DRAINS
CARP. SO FT.
DRAINAGE PIPING
WALL SO.FT.(d DRINKING FOUNTAIN
SO.FT.a URINAL
ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING
NOTE:Not to be used as property tax valuation FLOOR DRAIN
MECHANICAL FEES WATER SOFTENER
'VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTOXDISHI
APPLIANCE DRYER 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,TEMIPERM LAVATORY
HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER
BOILER B.T.U. SO.FT.®c BATH TUB
SO.FT.tg c WATER HEATER
MAX.HEATER OUTPUT,B.T.U. SO.FT.RESID 1 V.c SEWAGE DISPOSAL
SO.FT.GAR Q 3/4c HOUSE SEWER
GAS PIPING
PERMIT FEE PERMIT FEE PERMIT FEE
DBL TOTAL FEES MICRO FEE MECH.FEE aL.CK.FEE CONST.FEE ELECT.FEE SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 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.IEOUIP.
REINF.STEEL GAS(FINAL) TEMP.POLE
GROUT WATER HEATER SERVICE FINAL INSP.
Y
BOND BEAM WATER SYSTEM
GRADING
LUMBER GR. FINAL INSP. cu.yd.
FRAMINGFINAL INSP. $ plus x$ -$
ROOFING REMARKS:
VENTILATION ,
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR°
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL