002490 (RPL)Building 55"'554 Tree'Address
Owner
DM M&
Mailing
Address Sam
City Zip Tel.
Lt QUAIX". 92253
Contractor
City
Modio
State Lic.
& Classif.
359".r.
.
-Arch., Erigr.,
.Designer
P.O. BOX 1504 No.. UUZriU
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number
Legal Description
Ulm
Project Description ' '
922ol 345-5175
City
Lic. # 250
Sq. Ft. No. No. Dw.
Size Stories Units'
New ❑. Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State Pool mid
.. .. . 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 and Professions Codegaad`my license is in full force and
effect. ' rY /. r t i� r •. e—
'
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
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). '
❑ 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
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.)
0 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. 8 P.C. for this reason
ZONE:
Estimated Valuation
PERMIT
- -
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech. .. 7
Electrical
Plumbing
_
S. M. 1. .
Grading
-
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
D Copy is filed with the -city. .❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
work for which this permit is issued. (Seca 3097, Civil Code.)
Side Setback from Property Line
TOTAL
R
U.000.00
AMOUNT
16.00
SCa00
14.00
.74
.WORKERS' COMPENSATION INSURANCE EMARKS
(This section need not be completed if the permit is for one hundred dollars (8400) valuation
or less.) .. _
I 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.
Date "Owner
NOTICE TO APPLICANT: It, after making this Certificate of 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. (Seca 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 certify that I have
.q���
!
read this application and state that the above information is.correct.
I agree to
ISSued'by::
Date Permit
comply with all city and county ordinances and state laws relating to building .
construction, and hereby authorize representatives of this to enter the above-.
� rcity,
mentioned property for inspection purposes. fi•" f' r
Validated by:
Signature of applicant l +f Date
Mailing Address
Validation:
City, State, Zip
A 6 1 1 8
8 1 85,46 D,
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
ONDING
01
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO, 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.COOL 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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
OUND PLUMBIN a
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
ONDING
01
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TAN{
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
GREINF. STEEL g 1-r4
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 SIGNATURES/INITIALS.
GARDEN WALL FINAL