001995 (RPL)Building
Address
Owner
Address 75-005 ODWftl
Y (;gam Dr.
City Zip Tel.
aim 92260
.Contractor
£&V $ .ami and Marbanlim
Address
P.O. BOX 1504 NQ, 0019,5
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP:•
A.P. Number
!628- Legal Description
Project Description
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City .
Zip.
Sam
Tel.. .. .
State Lic.
City
& Classif.
Lic. #
Sq. Ft.
No. No. Dw.
Size -
-Stories_ Units'
-Arch. ; Engr.,
Designer
New a Add ❑
Alter ❑ Repair ❑ Demolition p
Address
Tel.
1 � mly . .
CityZip
State
_...
Lic. #
r LICENSED CONTRACTOR'S DECLARATION _• _
„
herebyaffirm that I am licensed under provisions of Chapter 9 (commencing with Section'
7000) of Division 3 of the Business and Professions Code, and my license is in full force'and'
-
. ..effect.
SIGNATURE DATE
" OWNER -BUILDER DECLARATION
EStlmated'V81UatlOn
.I hereby affirm that I am exempt from the Contractor's: License Law for the following
_!�__'
".fir'
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 •
h.
•..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 the Any Section 7031.5 'any for
-
Plan, Chk: Dep.
• -
alleged exemption. violation. of by applicant permit-'
subjects'the applicant to a civil penalty of not more than five hundred. dollars'($500).
Plan Bal.
❑ 1, as owner of the property, or my employees, with wages as their sole compensation, will
.Chk.
do the work, and the structure is not intended or offered for sale. (Sec. 7044,'Buisness andCOHSt.
Professions Code: -The, Contractor's License Law does,'not apply to an owner of'property who
•
'
builds or improves (hereon and who does such work himself or through:his own employees,
- Mech.
r
. 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
Pitt ~
j� t OID
of proving that he did not build or improve for the purpose of sale.)
_
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing -
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.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
O.I.am exempt under.Sec. B. 8 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, ora 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.
TOTALQ
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 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 thisCertificate oV Exemption- you should become '-
ZONE:
BY:
' 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 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
validated,
FINAL DATE
INSPECTOR
- This,ls a building permit *when properly filled out, signed and and is subject to
expiration if work thereunder is suspended for 180 days:
I
6
• . certify that I have read this application and state that the above information is correct.'
Issued by:
Date Permit
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. 1 _ / f
Validated by:
Y
Signature of applicant = �� ' X:% '• +✓r Dates !`�/i '
' Mailing Address
Validation:
City, State, Zip
A3Ia5
1 9 35.0E Ch
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. - SQ. FT.
POR. SO. FT. ®
GAR. SQ, FT. ®
CARP. 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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
T 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.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
• FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL