002538 (RPL)Building 54�24. iai
Address
Owner
Mailing
Address 75—W5 CMMLry Clams Drive
City Zip Tel.
..pain Desert 2260.
Contractor
Go He IS= Vanstrwtim
Address
68—Af—S, Pam rbad
City Zip Tel'.'
cu`� City 92234 328-268;
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. 00.538
BUILDING: TYPE CONST. OCC: GRP;-
A.P. Number
Legal Description
Project Description Pak
State Lic.
City
& Classif. 275796
Lic. # 69
Sq. Ft.
No. No. Dw.
Size •
Stories- Units,
Arch.;'Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
_..
Lic: #
LICENSED CONTRACTOR'S. DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division,3 of the;Business,an'd Professions•Code;`and:my,license is in full force and
effect. s> ? ' `^..,, '�£A w..e .. -- —�� f •..liy- 4d�
SIGNATUREDATE
• OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated V21Uatlon
$9,P000
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
requires the applicant for. such permit to file a signed statement that he is licensed pursuant to
••
PERMIT
_ AMOUNT '
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 Any 7031.5 by
Plan Chk.De p
the alleged exemption. violation of Section -any applicant for .a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). `
Plan Chk. Bal.
$ 60.32
❑ 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 and
Const.
80.50Professions
Code: The Contractor's License Law does not apply, to an owner of property who
builds, or improves thereon and who does such work himselforthrough his own employees,
Mech.
provided that such. improvements are not intended or offered for sale. If, however, thebuilding
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
12e00
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:I.
.67
such projects with a contractor(s) licensed pursuant to the Contractor'sLicense Law.) -
Grading
-
0.1 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. ❑ Certified copy is hereby furnished.
TOTAL
� �•��•��
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.) - - - -
certify that in the performance of the 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.
' Dale 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
Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Minimum
.
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 buildingpermit 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.
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 oY this city to enter the above-.
mentioned property for inspeon'pu�poses. ,fr ; <� _ _
Validated by:
Signature of applicant - +- ^"` bate X
Mailing Address
Validation:
City, State, Zip
B619,3
8 .-1.4 I%5..49 CK
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SQ. FT. ®
GAR. SQ, FT. ®
CAR P. SO. 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 APP.IEQUIP.
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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ pIUS 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
s
CERT. OCC.
FENCE FINAL
NSYtV I VK'J b1UNA 1 UKLbII VI I IAUk
GARDEN WALL FINAL