9837 (PLBG) 21- _ �
IE _
P.O.BOX 1504 No. 9837
Building 7&105 CALLE ESTADO
Address.. 4�J4� �Vlct'L LAQUINTA,CALIFORNIA92253
Owner'
Campion
Mailing .����
BUILDING: TYPE CONST. OCC:GRP.
Address
. A.P.Number
City Zip Tel.
a QtYinta 92253 Legal Description
Contractor Project Description
ECO' no Sewer Services
Address Sewer Hook Up
P. C?. Ear 29.2
City Zip . Tel.:
Palin Desert 92.262 346-2793
State Lic. City
&Classif. 480961 C42 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',undeAprovisions of Chapter 9(commencing with Section
7000)of Division 3 of the Business:an"d PProfessions Code,and my license is iin4611/fo?rce,and
SIGNATURE I L b.-.,..' I ".t DATE _
OWNER-BUILDER DECLARATION•
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation
reason: (Sec. 7031.5,81usiness 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). Plan Chk. Bal.
❑I,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 COrISt.
Professions Code: The Contractor's License Law does not apply to an-:owner of property who •a
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
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 30.00
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.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
WorkePs Compensation Insurance,or a certified copy thereof.(Sec.3800,Labor Code.).
Policy No. .Company.
`L]Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL 30.00
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation t,nrt rt1% 4A "" MIZ A'7-40-04
or less.) - d• ap 1 t��r -
1 certify that in the performance of thg work for which this permit is issued,I shall not af)w t;. o4}T ! A V �. '40400
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 Exemptionyou 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 FINAL DATE INSPECTOR
This is a building permit when properly filled out,signed and validated,and is subject to
expirationif 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
1 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
IST FL. SQ.FT.® $ UNITS
2N0 FL. SQ.FT.
YARD SPKLR SYSTEM
POR. SO.FT.® MOBILEHOME SVC. BAR SINK
GAR. SQ.FT.® POWER OUTLET ROOF DRAINS
CAR P. 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. 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. SQ.FT.RESID®11/4 c SEWAGE DISPOSAL
SQ.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 TANK 1 H WIRING. DUCT WORK ROCK STORAGE
FOUND.REINF. GAS(ROUGH) ,G 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
47e�7
CERT. OCC. v c
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL