002045 (RPL)Building
Address 55-1W Oak $ice
Owner
slirmi
Mailing
Address 75,005OXMil=y OMb
City Zip -
F,33 t Msert 92260
Contractor
43. H. Q
Address
City' '
. La Qainta
State Lic.
& Classif.
Arch., Engr.,---
Designer
Address
CV
P.O. BOX 1504 No. 002045
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
el.
568-2828
Tel.
92253 328-2681
City
Lic. #
Tel.
BUILDING: TYPE CONST.
A.P. Number
Legal Description
Pro'ect Descri tion PGA VE
♦.itac. •.r
-20XSa
Spa -- 10 x 10
OCC: GRP.
Sq. Ft. No. No. Dw.
Size Stories Units
New
Add ❑ ,Alter ❑ Repair ❑
Demolition ❑
-Kot ARr, -BE.ENGLOSED By
E-1 HIGH FENCE.
`k
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S. DECLARATION
I herebyyyyyy affirm that I am licensed under,,provisions of Chapte Mcommencing-with Section
7000) of v mn 3 o�ifie Business a+ annd=P,rofessions.Codei>and my license is in (full force andSELF-LATCHING.
effect. w�/�, i'�� ` / lyr f ? ye,
.
SIGNATURE 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
• permit 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
Estimated Valuation A np�� Anp�
S 20..0013.00
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 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
._
-Plan Chk. Dep.-
Plan Chk. Bal.
95,M❑
Const. I�:7. 50
-
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 of property who
Mech. i 00
. 2
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
Electrical ,��(}� .
orimprovement 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.)
�}rt .
Plumbing 18.40
❑ 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.) -
❑ I am exempt under Sec. B. & P.C. for this reason "
S.M.I.
Grading
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
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 3i'iiii116
_
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
"
(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 u
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.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
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.)
Side Street Setback from Center Line
Side Setback from Property Line
Lender's Name
FINAL DATE INSPECTOR
^�A ��JV
Issued by: Date Permit -
Validated by:
Lender's Address
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. certify that I have read this application and state that the above information is correct. -
1 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. /-%+ ► �r��_. _ _
Signature of applicant ! "" — Date — ! ` — 6
Mailing Address1
Validation:
A 4 2 2 9 2 12 3uG.16 (l
r
City, State, Zip M
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. p
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP.IEQUIP.
DRINKING FOUNTAIN
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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
ROCKSTORAGE
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.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSU LATIONISOUN D
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESANITIALS
GARDEN WALL FINAL