08027 (SATT)Itra
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NOTICE,. TO APPLICANT:. If, after making this Certificate of Exemption you should become
ZONE: -
'
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: -' `
_
,•" � J P.O. BOX 1504
QQ
No. Q@027'.
Building240 Riviera LA QUINTA CALIFORNIA 92253.
Address ,
- Owner•
colvsrRucnoN LENDING AGENCY
Sunrise Cmun
I hereby affirm that there is a construction lending agency for the performance of the
BUILDING: TYPE CONST:
OCC: GRP.-
•'Mailing.
Lender's Name
'
Address,
, ek lqfdta 9M
A.P. Number "
�Ir
zest
'City Zip Tel.
This is a building permit when properly filled out, signed and validated, and is subject to
,
Legal Description Tract
2111Ar-1;
'Pala enp
I certify that I have read this application and state that the above information is correct.
Issued by:
Contractor
Project Description Rhmito—��p�,►=Tom
N a R
'r Pam r
_
Address ' " '" ..
mentioned property for inspection purposes.
Validated by:
City ' Zip Tel.:
' Signature of applicant Date
State Lic. ; 1
City
Validation:
& Classif.- f $
Lic. # 328
Sq. Ft. I$29,'
No. No. Dw.
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Size
Stories Units
Arch., Engrr, •
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t.
''x
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Designer'
New ❑ Add ❑'
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City<
Zip
State
!_
.
_.,
Lic. #
LICENSED CONTRACTOR'S DECLARATION
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I hereby; affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000)tof Dmsion'3 of the Business and Professions Code, anyd, my license is in -full force.ansd
.effect f,�f (tr I�,FY"r >rr. �•^-''!
'fir �% iTh 1 t r
-
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SIGNATURE °--- ZWFE�
t, OWNER!BUILDER DECLARATION' ' I
'
Estimated Valuation
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I hereby affirm that I am exempt from the Contractor's License Law for the following
,• reason: (Sec. 7031.5,Buslness' and Professions Code: Any city or county which requires a
permit to construct, 'after, Improve, demolish, or repair any structure, prior to its issuance also
,. requires the applicant for such permit to rile a signed statement that he is licensed pursuant. to
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
• /or the;allegad •exemption. Any violation of Section 7031.5 by any applicant for a permit
Plan Chk. Dep.
_
` subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
I,
Plan Chk. Bal.
AS%
-. ❑ 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
k Professions Code: The Contractor's License Law does not apply to an owner of property who
Const.
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6V 650 •
Mech.
p}S
00
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;
. 12 -
or improvement -is sold within one year of completion, -the owner -builder will have the burden
or proving that he did not build or improve for the purpose of sale.) ,-
Plumbing
-
I31
- O I, as' owner of the property, am exclusively.contracting with licensed contractors to con-
struct the project. (Sec. 704'4, Business and Professions Code: The Contractor's License Law
S.M.I. ..
'
does not apply to an owner of property who builds or improves thereon, and who contracts for
_
such projectswith a contractdr(s) licensed pursuant to the Contractor's License Law.) -
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
2279,.43,.,.
less Credit
AM,43
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
0 Copy is filed with the city. . ❑ Certified copy is hereby furnished.
TOTAL
-2M.09 I
REMARKS
CERTIFICATE OF EXEMPTION FROM.
: WORKERS' COMPENSATION INSURANCE
(This section need not'be completed if the permit is for one hundred dollars ($100) valuation
g
• -'P?f � 'T^�!'t.. rF"g<_+f��e' '� • 1
or less.)
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'
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 Califorriia. '
Date Owner
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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, 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 -
colvsrRucnoN 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 it work thereunder is suspended for 180 days:
' +
I certify that I have read this application and state that the above information is correct.
Issued by:
Date �%�' Permit
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 purposes.
Validated by:
' Signature of applicant Date
iY .
Mailing Address
Validation:
City, State, Zip
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
2ND FL. SQ. FT.
FOR. SO. FT. ®
GAR. SQ, FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOMESVC.
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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT 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/a 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 APPJEQUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL