003660 (PLBG) ' I
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IE
1 P.O. BOX 1504 No. 003660
Building 78-105 CALLE ESTADO
Address 4()6,72 Airi'f I LA QUINTA,CALIFORNIA 92253
Owner _.
BUILDING: TYPE CONST. OCC:GRP. '
Mailing
Address Ate ,= A.P. Number Golf Erste tan
City Zip Tel.
at QuJinP4 Legal Description C011Tkifte� h0use. -gpwA-r to ri Vis►
ContractorProject Description
Address
City 7----7;p Tela
Indio 92201. 347-3629
State Lic. City
&Classif. 230 • Lic.# Sq. Ft. No. No. Dw.
101 Size Stories Units
Arch., Engr.;
Designer New ❑ Add ❑ Alter ❑• Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic.#
LICENSED CONTRACTOR'S DECLARATION, a M
1•hereb affirm that I m li nse under pro ' toofChapter 9(commencing with Section -
7000)of Divisio a usmess nd Pro ssio s e,and my license is in full force and
effect.
f/4/ .-.P ,� ..�.-s / .._.. _- ..
SIG A R T DATE .. -
OWNER-BUILDER DECLARATION Estimated Valuation.
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec.,7031.S,Business and Professions Code. Any city or county which requires a ,
permit io construct, alter, improve, demolish, or repair any structure, prior to its issuance also 'a'•
requires the applicant for such permit to file a.signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencingwithSection 7000) of
Division 3 of the-Business and Professions Code, or that.he ls'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,as owner of the.property,or my_employees with wages as their sole compensation,will Plan Chk._Bal.
do the work,and the structure is not intended or offered for sale.(Sec. 7044,Buisness and Const*'
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 Mech.
or improvement'is sold within one year of completion, the owner-builder will have the burden Electrical
.of proving that he did,not build or improve for the purpose of sale.) -
❑I,as owner of the property,am exclusively contracting with licensed contractors to con- Plumbing
• strucfthe 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
0 am exempt under Sec. B.&P.C.for this reason
Driveway Enc.
Date owner Infrastructure
WORKERS'COMPENSATION DECLARATION
I'heieby affirm that l 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.. ❑Certified copy is.hereby furnished. ..
TOTAL
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,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 this Certificate of Exemption you should become ZONE: BY: .
' subject to the Workers' Compensation provisions of the Labor Code, you"must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. '
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
This is a building permit when properly filled out,signed and validated,and is-subject to FINAL.DATE INSPECTOR,
expiration if work thereunder is suspended for 180 days.
I certify that l 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'relatirig 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
Mailing Address Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1ST FL. SQ.FT.® $ UNITS
2ND FL. SQ.FT.
YARD SPKLR SYSTEM
POR. SQ.FT.® MOBILEHOME SVC. BAR SINK
GAR. SO.FT.® POWER OUTLET ROOF DRAINS
CAR P. I SQ.FT.
DRAINAGE PIPING
WALL SQ.FT.
DRINKING FOUNTAIN
SQ.FT.® URINAL
ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING
NOTE:Not to be used as property tax valuation FLOOR DRAIN
MECHANICAL FEES WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH)
APPLIANCE DRYER GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT CFM KITCHEN SINK
ABSORPTION SYSTEM. B.T.U. 11TEMP 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 Q 3/ac HOUSE SEWER
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 EWER OR it ROUGH WIRING DUCT WORK
ROCK STORAGE
FOUND.REINF. GAS(ROUGH) METER LOOP HEATING(FINAL) OTHER APP./EOUIP.
REINF.STEEL GAS(FINAL) TEMP.POLE
GROUT WATER HEATER SERVICE FINAL INSP.
BOND BEAM WATER SYSTEM
GRADING
LUMBER GR. FINAL INSP. cu.yd.
FRAMING FINAL INSP. $ plus x$ _$
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