05556 (RPL)4 4 "
P.O. BOX 1504 No. 05556
Building 78-105 CALLE ESTADO
Address 55"'493 RIViM LA QUINTA, CALIFORNIA 92253
Owner SUMSE
Mailing BUILDING: TYPE CONST. • OCC: GRP. -
Address 42-600 COOK STRUT, #200 A.P. Number - - PCA EST
City Zip Tel.
PAT.14 DESERT 92260 568-2828 Legal Description
Contractor
C ft PQflL CONST Project Description POOL SPA
Address
68-463 PERE2 RD
City Zip Tel."
CATH. CITY 92234 328-2681
State Lic. City
& Classif. 275796 C-33 Lic. # 69 Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm thaLbarn licensed under propision"f Chapter9 (commencing with Section
7000) of Division 3 of the Business:and.Professiion's'Code, and mydicense'is:in;full force and
effect'. /. F .. s✓ �_ . =- . _ !.n ;
SIGNATURE / DATE
OWNER -BUILDER DECLARATION Estimated Valuation f
1 hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Bushess and RWessions Code: Any city or county which requires a
permit to construct, after; improve, derrafsh, or repair any structure, prior to its issuance also
requires Me aPPficant for such pemut to tae a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions of the Contractors License Law, Chapter 9 (commencing with Section 7000) of
sis
for n �� errpbon Any violation oBusiness and Professions f Section that.
7031.5 bymapnythapplicant for the
epermit Plan Chk. Dep.
subjects the applicant to a c" penalty of not more than rive hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 1 Z •±S
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 8 •
Professions Code: The Conbactoes License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees, Mech. 2 4• 0
provided that such irprovemerds are not intended or offered for sale. If, however, the building +Z tt [�fz
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical 30.00
of proving that he did not build or inprove for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con. Plumbing 27.00
slruct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. 1.26
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec_ w, 8 P.C. for this reason
Driveway Enc.
Date owner Infrastructure
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that 1 have a certificate of consent to.-seVnsure,ior a certificate of
Workers Compensation Insurance, or a ceRifi copy thereof: (Sec: 38 )( 0,�Labor Code.)
Policy No Company ✓! e4- it
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. ^+ • .. t !
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS )5$W%.'M) f 'A13.12 L272194, „ I ,..R Ly
WORKERS' COMPENSATION INSURANCE
(rhis section need not be completed ff the permit is for one hundred dollars (S100) 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, ff, after making this Certificate of Exemption you should become ZONE: BY:
subject to the workers' Compensation provisions of the Labor Code, you must forthwith
cane*wiMsuch provsamsorthis Permit shall bedeemed revoked. Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
Ihereby 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
Lenders Name
Lenders Address
This is a building permit when property filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 180 days. )�� f 9
I certify that 1 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 Dale
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE fL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
i
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
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
DFAC INSPECTION-
ool CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
1