14760 (POOL)77445 Loma Vista
14760
La Quin at, CA 93253 564-3727 Legal Description
` ContractorPflOI/.3p %iiA l'l,
C31?L1Y¢3 i3D°JX?a.S Project Description
ddress
-ciZip
Palm D�s6rtt CA, 92211 Tel.;�+�iv®90flEk
State Ic. 3_ ' 655a 28.- City 35
&Classrf.. n Lic. # Sq. Ft.
5
Size -
Designer New ❑
Address Tel.
CityZip State
LIC. #
No. No. Dw.
Stories Units
Add ❑ Alter ❑ Repair ❑,
.LICENSED CONTRACTOR'S DECLARATION'
I hereby affirm; hatil am lice sed under Provisions of Chapter 9 (commencing with Section
• 7000) of Division 3 of the Businegs�ssAnd Professions Code, and my license ts-in fulll.force and
effect .. f�°. , ���e�� . t<r �, ✓ �' ��
SIGNATURE .41' !ii v ' f ' DATE
'OWNER•%diER DECLARATION
affi
I hereby rm that I am exempt from the Contractors License Law for the following
Estimated Valuation q A�r� A +
r.I .•1806i ��iJ
. reason:, (Sec. - 7031: 5, Business. and Professions Code: Any city or county which requires.'a
permit to construct, atter, Improve, demolish, or, repair any- structure, prior to. its issuance also
I - -
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 lha6 he is exempt therefrom,vand the basis • --
for the alleged exemption. Any violation of Section 7031.5'by any applicant fora permit
- '
Plan Chk.. Dep,'_-
" subjects the applkariI to a ctvfl penalty of not more than five hundred dollars ($500). -
-
Plan Chk. Bal. 122-85.,
O I, as owner of the property, or my employees with wages as their sole -compensation, will
do the work, and the structure is not Intended or offered for sale.. (Sec. 7044; Buisness and
_ 7.
Const.
Professions Code: The Contractors License Law does not apply to anownerof property who
builds or Improves thereon -and who does. such work himself -or through. his own employees,
_ '-
Mech.'
.provided that such Improvements' are not intended or offered for sale. If,: however, the building
or improvement is sold within one year of completion; the owner -builder will have, the. burden
,;.'.•
_
Electrical a' -•'o -45.00-.
of proving that he did.not build or improve for the purpose of sale.) .. , ,
0A, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing° ,
struct the project. (Sec. 7044; Business and.Professions Code: The Contractor's'License Law
- ..
does not apply to an owner of property who builds or Improves thereon, and who contracts -for '
- such projects with a contractors) licensed pursuant to the Contractor's License Law.)
_
S.M.I. - r
_
i
• ❑ I am exempt under Sec. B. 8 P.C. for this reason
Grading
-
r .
Driveway Enc.
Date Owner -r
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a`oertificate of consent to self•insurd, or a certificate of
—
Worker's Compensation Insurance, ora certified copy.thereof. (Sec. 3800, Labor.Code.)-
•-
Polic�No. .Company
t�opy is filed with the city. ❑.Certified copy. is hereby furnished.
. • _
TOTAL 407.85
' CERTIFICATE OF EXEMPTION FROM .'." ".. •.'
- WORKERS' COMPENSATION INSURANCE '
•
REMARK
(This section need'not be completed If the• permit Is for one hundred dollars ($.100) valuation
'
.. ., .. .. ..
, or less.)
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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' Coinpensalloh provisions of the Labor Code, you must -forthwith
comply with such provisions or this permit shall be deemed revoked.
. • Minimum Setback Distances:. _
Front Setback from Center.Line
'
.. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND- •
Rear Setback from Rear Pop. Line
/.
" Side $freet'Setba f�roj Center -,Line
SHALL' SUBJECT AN EMPLOYER' TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
-ADDITION
f
.HUNDRED THOUSAND DOLLARS.($100,000), IN TO THE COST OF COMPENSATION,
Side Setback from soperty'tineli
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE, LABOR. CODE`.. INTEREST, AND.
ATTORNEY'S FEES.
' ' This Is a buildind peimit when properly.filled out,.signed and validated,'and is subject.to.. '
expiration if work thereunder is suspended for 180 days:
FINAL DATE INSPECTOR �!
(;certify. that I have read this application and state that the above information is correct.
I
'-'Issued by `Data-�-effrllt
fes'
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
1nn
� l99'
, .
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date
G,////
Mailing Address
Validation: l
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. @ $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT. ®
— '
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SO. FT. @
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT.
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.0OOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
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, TEM/PERM
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 j HEATING & AIR COND. SOLAR
I If A r%
SETBACK/
GROUND PLUMBI �f
UNDERGROUND � G
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
AS (ROU ) j �/
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT.
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus
,
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
glrA�
/f /J/ /�
,(rS 31 ,S
REMARKS:
VENTILATION
FIRE ZONE ROOFING -
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL