001912 (RPL)Building
Address 55-473 Oak RM
Owner
Mailing
Address 75-005 Com,
CityZjp
.. . lxa 9
Contractor
4
P.O. BOX 1504 N o . .001912
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253 .
BUILDING: TYPE CONST: OCC: GRP.
fib Drive A.P. Number
Tel.
2
260- 568-2828 Legal Description
Project Description t
--
6&465 pexez W.
City Zip " -
Tela
328-x681
State Lic.
City
& Classif.
r �'
Lic. # P
��
Sq. Ft.
No. No. Dw.
Size
Stories Units
- ....
Arch., Engr.,
Designer
New .C_ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LI_CENSED CONTRACTOR'S DECLARATION
_
hereby affirm that I am licensed under provisions•of phapter9,(commencing with Section
7000) of Division 3 ofi-and;Professions'Code-and•mylicense is in full force and
effect.
I
SIGNATURE DATE
-.
' r - ' ' OWNER -BUILDER DECLARATION
Estimated Valuation
hereby affirm that I am exempt from the Contractor's License Law for the'following
'a
00
reason: (Sec. 7031.5,Business and Professions Code: Any. city or county. which requires
permi('to construct, alter, 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
s�-
-
- 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 Section 7031.5 for
Plan Chk.:Dep.
the alleged exemption. violation of by any applicant a permit
' 'subjects the applicant to a civil penalty of not more than five hundred dollars'($500). -
Plan Chk. bal.
64.02_
q 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
C nst.
. Professions Code: The Contractor's License Law does not apply to an owner of properly who
builds or improves" thereon and who does such work himself or through his own employees,
Mech.
17.50tA
50
�. 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
12.50
. of proving that he did. not build or improve for the purpose of sale.)
'licensed
O I, as owner of the property, am exclusively contracting with contractors to con-
Plumbing
14.00
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law -
does to builds improves -thereon; for
S.M.I.
-
not apply an owner of property who or and. who contracts
- such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
.83
0 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date owner"
Infrastructure
WORKERS' COMPENSATION DECLARATION
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. .O Certified copy is hereby furnished. .
TOTAL
207.40
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.) -
I certify that in the performance of Ing 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
'ZONE:
� BY:
subject to' the Workers' Compensation provisions of the Labor Code,' youmust' forthwith.
comply with such provisions or this permit shall be deemed revoked. -
Minimum Setback Distances:
-
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 validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I
�� Permit
certify that I have read this application and state that the above information is correct.
Issued by:
Date
1'agree to comply with'all city and county ordinances and state laws relating to building.
construction, and hereby authorize representatives of 'this city, tormenter the above-,
mentioned property for inspection purposes!
Validated by:
Signature of applicant
Mailing Address ab "
Validation:
City, State, Zip
A3505
12 9 2t, 7,40 CK
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST 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.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
LAUNDRYTRAY
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:
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
q .2//8t .�
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
Nsrtc I %JN a blUNA I UNrWINI i IALs,
GARDEN WALL FINAL