15650 (RPL)1
P.O. BOX 1504 No. 15650
BuildingAddress 4 X75 Seeley D� • LA QUINTA, CALIFORNIA 78-495 CALLE C9 2531,,,
Owner Stephen & Lynn Ziem
Mailing - BUILDING:, TYPE CONST.` OCC: GRP.
Address Ssi3e
A.P. Number
..CityZip Tel. '
Tia Quix2 CA 92253 Legal Description
Contractor Project Description
Address
73--011 dountry Club De.
<'_Pi91M Desert, 4'p 92260 T146-4032 `
State Lic. City '
8 Classif..574127 Lic. # 1044 Sq. Ft. No: No. Dw.
Arch., Engr.; ;,' Size Stories Units
Designer New ❑ Add ❑ , ', Alter ❑ Repair ❑ .'Demolition.❑
Address Tel. 0r
City Zip State
Lic. #
_s LICENSED CONTRACTOR'S DECLARATION
I herebyy.affirm 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 -
I hereby affirm that 1'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 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
for the alleged 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. 87.75
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
Professions
Const.
Code: The Contractor's License Law does not apply to an owner of property who
bunds or Improves thereon and who does such work himself or through his own employees,
.0
Mech.24 0 -
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 45.00
. 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 L'p
strucl 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 contractors) licensed pursuant to the Contractor's License Law.) -
•�,,
S. M. 1.
- -
❑ I am exempt under Sec. B. 8 P.C. for this reason
p
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
❑ Copy is filed with the city, O Certified copy is hereby furnished.
TOTAL t 313. 75
.� 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 the work for which this permit is issued, Ishall not
employ any person in any manner so as to.become subject to the Workers' Compensation
Laws of California
Date Owner
- NOTICE TO APPLICANT: -N, aRer,making this Certificate of Exemption .youshould 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 C' enter Line
Rear
Setback from Rear Propi Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
-- ��'� •� -
Side Street Setf)ack from -,Center Line
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP,TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
Side'Setback from.P7roperty L ne�
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
�� (/ \j'
FINAL DATE �G INSPEQTQ R
This is abuilding permit- when properly filled out, sighed and validated, and is subject to
expiration it work thereunder is suspended for 180 days. : •
�, T
I certify that I have read. this application. and state that the above information is correct. ••
I agree to comply with all city and county ordinances and -state* laws relating building
Issued by: Date\ !Pe'rLmit /1
: •
-
construction, and hereby authorize representative.of this city to .enter thh e above-
sthe
• • - \\ J
mentioned property for Inspection purposes.
Validated by:
Signature of applicant Date\
_Mailing Address
Validation: -
City, State, Zip
s,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIWU FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT.
SO. 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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAS (ROUGH)
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.
SQ. FT. ® c
BATH TUB
GROUT
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
LUMBER GR.
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING AI ELECTRICAL J
HEATING & AIR COND. SOLAR
> >
SETBACK
GROUND PLUMBINGUNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
V
HEATING (ROUGH)
STORAGE TANK
FORMSSEWER
OR SEPTIC ANK
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.
ROOFINGv�
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-01010
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUREWINITIALS
GARDEN WALL FINAL