002502 (RPL)P.O. BOX 1504 No. 002502
Building 78-105 CALLE ESTADO
Address 54-492 Oak Hill LA QUINTA, CALIFORNIA 92253
Owner
Mailing '
Address 7 5-005 Cbmtry C111b.
City Zip P
l.
92260 568-2828
Contractor
Address ...
Sam
City Zip Tel:
State Lic. City
& Classif. 8130 Lic. # 329
Arch.,'Engr., .
Designer
Address Tel.
CityZip 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 Busiriess and Professions Code, and my.liceh-sse is in full force -and
effect. f . " " - ,,�.. ! �; r' 1 ? _A,
SIGNATURE 1-,i '-`-- V� - DATE
OWNER -BUILDER DECLARATION
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 •_
"permii to construct, alter, improve, demolish, or repair any structure, prior to its.issuance� also
requires the appiicanl for such permit to file a signed statement that he is licensed pursuant to
.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
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their.sole compensation,.will.
do the woik, 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 of property Who
builds- or improves thereon -and who does such work himself or through his. own employees,•
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
of proving that he did not"build or improve for the purpose of sale.) .
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
0 am exempt under Sec. . B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent 'to seWinsLre, 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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
- employ any person in any,manner so as to become subject to the Workers' Compensation
Laws of California.
Date' Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you. should become
subject to the Workers' Compensation provisions of the Labor Code, you •must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there "is a construction lending agency for the'performance of the
.work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days."
1 certify ,that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws *relating to building
construction, and hereby authorize representatives of . this city to enter the above-.
mentioned property for inspection purpose's.
Signature of applicant % r� '� r✓�l' -::* ... 1 Date r .
Mailing Address . r " '•�
City, State, Zip
HARD COPY
iBUILDING: TYPE CONST: OCC. GRP.-
A.P. Number
,Legal Description
Project Description P.H•A� VEM Phase Q A
Sq. Ft. No. No. Dw.
Size " Stories Units
New. Qr Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
BY:
PERMIT
AMOUNT
Plan Chk. Dep. . .
Plan Chk. Bal.
Corigt. .
Mech.
Electrical -
22.50
" Plumbing
Date 7-29—$(Permit
S.M:L .
Grading
Validation:
Driveway Enc.
Infrastructure
1 29 225L U
TOTAL
22.50
REMARKS, .
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 7-29—$(Permit
Validated by:
Validation:
A6011
1 29 225L U
CONSTRUCTION ESTIMATE
NO. 11 ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT. ®
POR. SO, FT. ®
GAR. } SO. FT. ®
CAR P. SO. FT.
WALL } SO. FT. ®
SO. 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
j MECHANICAL FEES
FORMS l
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 APP./EOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT i 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 ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
1
GAS PIPING
PERMIT FEE j
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
+1
i
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE I PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK 1
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE ,
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS l
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
REINF. STEEL l
GAS (FINAL)
TEMP. POLE
GROUT h '
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 1
SPARK ARRESTOR I
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL i
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALLFINAL