08461 (SFD)+ '':rte -•;•f .l•• ..
Building
Address 80-035 MERTON
Owner.
SHNRI SF''COM PAN
Mailing ,
AddressCOOK RT,
_
City Zlp
�.untractur �.
7'-
W4 A
Address . , r tztR r sv ♦ a
l41CJF 5
City .y Zip,
State Lia 2.8813.0
& Classif. z
Arch.,-Engr:;
Designer
Address t
City Zip
-'
LICENSED CONTRACTOR'S DE
-
I hereby affirm that I am licensed under provisions of
7000) of Division 3 o the nBusiness �-46 i
and C (
affect--' '�
p>s 3El3' .
P.O. BOX 1504 N o . -0,8461
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST.OCC: GRP..'
A20n A.P. Number Pr -h mar_ xaAar 12509-3
e rY'777
Legal'Description '
Project Description R- A a. s: 3C - 01 Am r=3A
Tel.'
City
Lic. #
Tel.
State
Lic: #
ARATION
Spier 9 (commgncsng with Section
and my licefs-in full force and
Sq. Ft.
Size a
IW
New ❑
N o:
Stories
r
Add ❑• '. , Alter ❑
J
Units - .
Repair ❑
t r ,
Dernolition;❑j
s .- -rte ii /[• . r•. r , f -.,....LP-- -.• :g-,,-, ..-. t r �'l
_ •
' �GfYATURE 3�•e.wL.t.t'e.'a :rr+:: = .IX .. y Fe„r.�•. . nr...-;. •< /DATE
{�¢ OWN ER -BUILDER DECLARATION','
I her by affirm thaat'I,'am exempt from the Contractors License Law for the following
Estimated Valuation
' reason:,*(Sec. 7031.5)Business and Professions Code: Anyl,city or county which requires a
'
permit to construct,' after, Improve, demolish, of repair any structure, prior to its,issuance also
- ,
:+ requires the applicant for such permit to:file a signed statement that he is licensed pursuant to
PERMIT.'"- •r ` • AMOUNT
•the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
-
• . Division 3 o/ 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 penally of not more than five hundred dollars ($500).
'
Plan Chk. Bal. -Timu,30
O 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 an!Sy
"a
Const.
Professions Code: The Contractor's License Law does not apply to an owner. of property who •.
_ 03
builds or improves thereon and •who does such work himself or through his own employees,
- '
U.50.
provided that'such improvements'are not intended or offered for sale. 1/, however, the building
.MBCh.'
.� 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. /or the. purpose o/ sale.) - -
• ❑ 1, as owner of the property,•am exclusively contracting with licensed contractors to con.., .
Plumbing
*struct the,projeet.. (Sec: 7044, Business and Professions Code: The Contractor's License Law
„• does not apply to anowner of property who builds or improves' thereon, and who"contracts.for
`• $,M.l.•�
.' such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - -
- -
_
-
Grading
• • O 1 am exempt under Sec. - B. & P.C. for, this reason
,
,Driveway Enc. ,
Date owner
Infrastructure
I ESS EMIT 3;000
r
WORKERS' COMPENSATION DECLARATION-
fi 1
'433'
a'-1•hereby affirm that;I have a certificate of consent to self -insure; or a certificate of
' r*�
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
-.•,..Company
';•Policy.No:
- ❑ Copy is filed with the city. O Certified copy is hereby furnished.
' °3" ..
,TOTAL
' CERTIFICATE OF EXEMPTION FROM
REMARKS ' i
WORKERS' COMPENSATION INSURANCE
.•
° (This'section need not be completed. if the permit is for one hundred dollars ($100) valuation
- ° ^•- :� :•
-da
or less.) - - - -.- ; -
certify that in the performance of the work for this is issued; l
hh
.. 2 S? 8 J�� 4
f r1ytfrAt.
which permit shall not
employ any person in any manner so as to become subject to the Workers' Compensation
, , rE,7
_
Laws of California.
Date Owner '
• NOTICE TO APPLICANT: If, alter making this Certificate o/ Exemption you should become
ZONE.` ' BY: J
- 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 fiom Center Line
_
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY`
Side Street Setback from Center Line
Ihereby 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 Linea ,
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.
_
1 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:
..Validated
Signature of applicant Date
r.
Mailing Address
; "Validation:
-City, State, Zip
7 • -
r 'a '' � ty / `' <.. Y•' a `.t } t ..kn - d-'.1"i� f.. -.
tya �r * fu:..� <i �'1'� •r _ i' ">•i -F f, s ~7
s
•1_ n �.Y.::--S..i,; 13 ��- `; � r � -.rXr •.: . vs..,Z-�'4
._. .! .k a/Y t� .. ..!_ :-S }..'.,R t 'V?'•.. f•.� t(� Vi �! r T+ .. i•, :hR ,rj v� „r:�Fhi. _ i'` .'+•r of rf. �r.d4. _e
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. 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.000L HOOD
SIGN
WASH ER(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, 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/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
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
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL