9775 (PLBG) II�IIIIIIIIIIIIIIIIIIIIII 24 �.
IE No. 9775
4
- P.O. BOX 1504
Building
Address 49--506 Avila LA QUINTA,CALIFORNIA 92253
Owner
HiCfhgenboten
Mailing BUILDING: TYPE CONST. OCC:GRP.
Address
A.P. Number
City Zip Tel.
La Qui33``i.s 225 Legal Description
Contractor Project Description
Econo Sever Services
Address Sewer Hook Up
P. 0. Box 192
City Zip Tel.:
Pala Doser, 9226:1 346-2793
State Lic. City
&Classif. 460961 C 42 Lic.# 342 S Ft. No. No. Dw.
Arch., Engr.,
Size Stories Units
•
Designer New ❑ Add ❑ Alter❑ Repair❑ -Demolition ❑
Address Tel.
City Zip State
Lic.#
LICENSEDICONTRACTOWS DECLARATION
I hereby affirm that I am Ilcensad undo?provisions of Chapter 9(commencing with Sectlpn
1000)of Division 3 of the Business andProfessions Code;andmylicense Is In ful fort end
effect. y
SIGNATl1RE,e . '�-G !✓DATE
.'_' OWNER-BUILDER DECLARATION Estimated Valuation
I hereby affir/n that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8usiness 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 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 8 (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(8500).
0 1,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, Mach.' R'
provided that such Improvements are not Intended or offered for sale. If, however, the bullding
or Improvement Is sold within one year of completion, the owner-bulider will have the burden Electrical
of proving that he did not build or Improve for the purpose of sale.)
O I,as owner of the property,am exclusively contracting with licensed contractors to con- Plumbing 30.U U'
struct 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.
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 s1�-� �,1_ A¢'�;"`� f :4
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.)
Pollcy'No. Company
yO 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/f 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 pparson In any manner s0 as to become subject to the Workers'Compensation
Lows of California.
Date Owner
NOTICE TO APPLICANT: If, alter 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.3087,Civil Code.). Side Setback from Property Line
Lenders Name
Lenders 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. S0.FT.
YARD SPKLR SYSTEM
POR. SO.FT.® MOBILEHOME SVC. BAR SINK
GAR. SO.FT.® POWER OUTLET ROOF DRAINS
CAR P. I S0.FT.
DRAINAGE PIPING
WALL SO.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 LAUNDRYTRAY
AIR HANDLING UNIT CFM 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. SO.FT.®c BATH TUB
SO.FT.®c WATER HEATER
MAX.HEATER OUTPUT,B.T.U. SO.FT.RESID®11/4 c SEWAGE DISPOSAL
SO.FT.GAR®3/ic 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 TAN GH WIRING. DUCT WORK ROCK STORAGE
FOUND.REINF. GAS(ROUGH) METER LOOP HEATING(FINAL) OTHER APP.IEOUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION l ar L
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
-d,