9853 (PLBG) IIIIIII VIII III VIII(III 45 1 ��
IE
P.O. BOX 1504 �(- - No. 9853
Building 78-105 CALLS STA 92253'
Address 49-578 ABILA DR. LA QUINTA,CALIFORNIA 92253 P-">
Owner /
SILLMAIv'
Mailing BUILDING: TYPE CONST. SEWER
Address SAME
A.P. Number
City Zip Tel.
LA QUIRTA., CA 92253 1 Legal Description
Contractor Project Description SEWER HOOKUP
EdO O SEWER
Address
P 0 BOB 192
CityZi Tel.:
PALM DESER 2260 346-.293
State Lic. City
&Classif. 480961 Lic.# 342 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 that I am,licensed.under provisions of Chapter 9(commencing with Section
7000)of Division 3 of the Business d'Professions code,and my license is in full force and
effect. >:" , _/�-�
SIGNATURE— -, I.- %__ DATE
✓/ OWNER-BUILDER DECLARATION C
I hereby"affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation 15QQ�00
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 AMOUNT
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT �•'
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(S500). Plan Chk. Bal
❑I,as owner of the property,or my employees with wages as their sole compensation,will C@
do the work,and the structure is not intended or offered for sale.(Sec. 7044,Buisness and Const. yn ��
Professions Code: The Contractor's License Law does not apply to an-owner or property who
builds or improves thereon and who does such work himself or through his own employees, Mech. -
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
or 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
strict 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.1. '
such projects with a contractor(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
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 ce i py ereol(Se, 80 ,Labor Code.)
Policy No. Company " �j� tZ,� .
Copy is filed with the city. ❑Certified copy is hereby furnished.
I ".' TOTAL S a
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 thF work for which this permit is issued,I shall not itirtt s mrt A t%--'R AriA. !�7._{!z Cad 40
=any person in any manner so as to become subject to the Workers'Compensation w 'rh Y f.
Laws of California. y0 y ;,t�;l t�J to .iV.
Date Owner +�A
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
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
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 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
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1ST FL. SO.FT.® $ UNITS
2ND FL SO.FT.
YARD SPKLR SYSTEM
POR. SQ.FT.® MOBILEHOME SVC. BAR SINK
GAR. SO.FT.® POWER OUTLET ROOF DRAINS
CAR P. SO.FT.
DRAINAGE PIPING
WALL SQ.FT.
DRINKING FOUNTAIN.
SO 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. 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
SQ.FT.®c WATER HEATER
MAX HEATER OUTPUT,B.T.U. SO.FT.RESID®1%c SEWAGE DISPOSAL
SO.FT.GAR®3Ac 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 . 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
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