15035 (BLCK) IIIIII�III�IIIIIIIIIIIIII 63
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P.O.BOX 1504 No. 15035
Building 78-495 CALLE TAMPICO
Address 80-800 Avenue 58 LA OUINTA,CALIFORNIA 92253
Owner
South Valley Estates BUILDING: TYPE CONST. OCC.GRP.
Mailing
Address 41-910 Doardwalk Suite A-10 A.P. Number s
City Zip Tel.
Palm Desert y226� 776-48419 Legal Description
Contractor Project Description 4,100 1€ of 6' ®rco Wall
..Rob °psi 10r masonry
Address.
42-200 Beacon Hill Suite A
City Zip Tel.:
Palm Desert 92260 773-0012
State Lic. City
&Classif. 629176. Lic.# 1246 Sq.Ft. No. No.Dw.
Size Stories Units
Arch.; Engr., -
Designer New ❑ Add ❑ Alter❑ Repair❑ Demolition ❑
Address Tel.
City Zip State
Lic.#
i
,. LICENSED COKLRACTOR'S DECLARATION r,r+
I hereby affirm the am'Iriused u�r Provisions of Chapter 9(commencing with Section
7000)of DivI of'the.Bu9mess and Professions Code,and my license is inAAfi lyforce n
effect. ns f
f.1+ r
GN • ! r DATE I O
(p OWNER-BUILDER DECLARATION Estimatt=d-Valuatiori
I hereby�ffirm4hat I am exempt from the Contractors License Law.for the following _ 0
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 f' j
requires the applicarit for such permit to file a signed statement that he is licensed pursuant to F' ERMIT,` AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
.the
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.,.DeR, f ,�
subjects the applicant to a civil penalty of not more than five hundred dollars(8500). z �.
.O I,as owner of the property,or my employees with wages as their sole compensation,will Plan Chk„_Bal:'1'—�"
do the work,and thestructure is not intended or offered for sale.(Sec. 7044,Buisness and Const.
Professions 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, 'Mech.
provided that such improvements are not intended or offered for sale. If, however, the building
orimprovement 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.)'
O I,as owner of the property,am exclusively contracting with licensed contractors to con- Plumbing
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.IM.I•
such projects with a contractor(s)rrcensed pursuant to the Contractor's License Law.)
ja I am exempt under Sec. B.&P.C.for this reason 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
O Copy is filed with the city, ❑Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATIONINSURANCE
(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: g, after making this Certificate of Exemption you should become ZONE: - BY:
subject to rhe Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this parmif shall be deemed revoked.
Front Setback from Center Line
Rear Setback,from Rear Prop. Line
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND Side Street Setback 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 Property Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
This)s a building permit when properly filled out,signed and validated,and is subject to FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 160 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. PLUMBINU 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 SO.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. SO.FT.®c BATH TUB
SQ.FT.®c WATER HEATER
MAX.HEATER OUTPUT,B.T.U. SQ.FT.RESID®1'A c SEWAGE DISPOSAL
SO.FT.GAR®3/ac HOUSE SEWER
GAS PIPING
PERMIT FEE PERMIT FEE PERMIT FEE
DBL TOTAL FEES MICRO FEE MECH.FEE JPL.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
INSULATIONISOUND
F ISH GRADING
NAL INSPECTION 2
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL