RPL (09258)TA. hf
,
y P.O. BOX 1504N
Building 78-105 CALLE ESTADO •
Address 8Q--135. -Vier ion _ LA QUINTA CALIFORNIA 92253
o .
� •,'
Owner-
_'
Mailing
BUIL TYPE CONST.'.. OCC: GRP. '•• +
:.
Address 42 -600' S ook $.agree #200
A.P. Number '
City Zip Tel.
Palm Desert 9226 558-2826
Legal Description
Contractor. _
Project Description
tr � 1 17,r$�tr sIe`�...siinln-
- Address . , .
Address
.
vol'' ' Tat$ . Spa -
68-465 Perez Road
h•
7
City Zip TO,:
.Cat. 1.92234 328 -2681
State Lic.
City
'
,'
& Classif.C 275796
Lic. # 6�
Sq. Ft:
Size
,No. " '' `- No. Dw.
Stories ` Units
.Arch. Engr.,
' 'Designer, "
New ❑' Add ❑ Alter ❑ Repair ❑ Demolition b..
Address
Tel.
,..
City
Zip
State
Lic..#
r
LICENSED CONTRACTOR'S DECLARATION '
r••
• I hereby affirm that I am licensed under provisi i of Chapter 9 (commencing with Section
7000) of Division 3othe Business andProfessio'ns Code,.and'my license is in full force'and
effect.
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- - '--•
• '
SIGNATURE r' (f .t - .DATE -
---OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's. License Law for the following
. '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
requires the applicant for such permit to file a signed statement that he is licensed. pursuant to
'*tithe -provisions -of the Contractor's License Law,. Chapter 9 (commencing with Section 7000) of
Estimated Valuation.
_
PERMIT
-
r AMOUNT".
,
"'Division 3 of the Business and Professions Code, or that -he is exempt therefrom, and the'basis
;Ifor'•the alleged exemption. Any violation of Section 7031.5 by 'any _applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars.(8500).
_ 0 I, as owner of the property, or my employees with wages as their sole compensation, will .
Plan Chk..Dep.
-
Plan Chk. Bal:
-
122-85
' do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
., Professions Code: -The Contractor's License Law does not apply to an owner. of property;. who
.
COnSt_
��
s -
Mech.
^•♦�7 pin _
- 24 00
builds or, improves' thereon and, who does such work., himself - or. through his own employees,
provided that such Improvements are not intended or offered for sale.. If, . however, the building.
Electrical
-
00
or improvement is sold- within one year of completion; the owner -builder will have the .burden
of -proving that he did not build or improve for the purpose of sale.)
Plumbing��
�-
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
' slruct 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 contractor(s) licensed pursuant to the Contractor'sLicense Law.)
' ❑ I am exempt under Sec. - B. ix P.C. for this reason
..
S. M. 1.
- -
- -26
Grading •--
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
1 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
yopy is filed with the city... O Certified copy is hereby furnished.,,
TOTAL
i4+Q_ 1
REMARKS
CERTIFICATE OF EXEMPTION FROM
• 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 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 •
subject to the Workers' Compensation provisions of. the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
• —
- - ,z, '�,�'4u;�`: y ';; ._ %i,���k.'�;j�,
.. e
- ZONE: - ' ' BY:
- - - -
Minimum Setback Distances: _ -
Front Setback from.Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line =�
CONSTRUCTION LENDING AGENCY'. --
hereby affirm that 'there is a construction lending agency for the performance of the
work, for which this permit is issued'. (Sec. 3097, CivilCode.) ' .`.
y'hSide
Setback from Property Line
Lender's Name
_
FINAL DATE
, -
INSPECTOR
- Lender's, Address
This is a building permit when properly filled out, signed and.validated, and is subject'to
expiration it work thereunder is suspended for 180 days.
' I certify that I have.read this application and state. that the above information is correct.-
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.
Issued by:
. �- .
Validated by:,
Date Permit.
•
Signature of applicant' Date'
Mailing Address
Validation:
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M "s? �.� R ; 'aJH Yi.,iy,5 :1c
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City, State, Zip
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. '@
CARP. SQ. FT.
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
MIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE rPL.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
cu. yd.
$ plus x$
_$
LUMBER GR.
NAL IN _ :`
FRAMING
FINAL INSP.
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 SIGNATURES/INITIALS
GARDEN WALL FINAL
f
_
SIGNATURE' :.,o,•-•r..a ,•-.::.7 +.,f.. «,..•_.. Y� ATE
- •--
(.�
Building
, ALJ
' Address
- Ihereliy affirm that'l am exempt from the Contra
Contractor's License Law for the following
Owner ..
' reason: (Sec.,, 7031 5,Bbs1hess and Professions Codd:,fAny city or county which requires a
SUNR I SE CON
• Mailing
Address
" � ri
City
-
'�'IZIp
the provisions of the. Contractor's License Law, Chapter 9 (commencing with Section 7000) of
"•
contractor or, )
Address
a
City Zip
State Lic.
& Classif. : 288130..
*Arch., Engr.,
Designer
Address
City Zip
LICENSED CONTRA(
r
,,I hereby affirm that l am licensed under pros
7000)nof. Division 3 ofrthe Business and Profe:
4t .4
PgAsE 3t/OA,
P.O. BOX 1504 No. 02459.-
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
• ,,�,• .• .. ;� til-- � _ ' �" BUILDING: TYPE TYPE CONST.' OCC: GRP.
C t A.P. Number P7` R WE&T TFo ,T + stALL ,
03— Legal Description «
-2828
Project Description a1u a r•r_ '+ir. r a N! 663A
Tel..
City
Lic. # -
Tel.'
State
LIC. #
iDECLARATION
of Chapter 9 (corgi
Code, and my licen
Sq. Ft.
Size ..
New ❑
` t ,
t No.
Stories' -
Add '❑ ' ' Alter ❑
3 with Section I
full force.and
No. Dw.
Units
Repair ❑
}
=0.
SIGNATURE' :.,o,•-•r..a ,•-.::.7 +.,f.. «,..•_.. Y� ATE
Y
OWNER•BUILDER DECLARATION
- Ihereliy affirm that'l am exempt from the Contra
Contractor's License Law for the following
Estimated Valuation
' reason: (Sec.,, 7031 5,Bbs1hess and Professions Codd:,fAny city or county which requires a
-j� �• ,)
2 -72 -603.00 -
permit to construct, -after, Improve, demolish, or repair any structure, prior to its issuance also
r-,.
requires the applicant for such permit to file 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, thathe is exempt therefrom, and the basis -
`Plan
•. t - -
_.- for the alleged ~exemption.. Any violation - of Section 7031.5 by any applicant for a permit
Chk. Dep.-
•r'
. subjects the applicanhto a civil penalty of not more than five hundred dollars ($500). --
as '
-.'Plan Chk. Bal.
• ,'
;
O I, 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
Const..
; 7
Professions Code: The. Contractor's' License Law does not apply to an owner of Properly who '•
' -00
builds or, improves. thereon and. who does such work himself or through his -own employees,,
Mech.431
50
.,. provided that. such improvements are not. intended or offered for sale. If, however, the building
or improvemenhis 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 coritractors 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.M.I.
'`�• '.
-i
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
6,0001,00 3000"00 It
S., '
i
WORKERS' COMPENSATION DECLARATION \
R '�.431 -
1 hereby affirm that I have a certificate of consent to self -insure, or, a certificate,ofF!J
- 1
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
_
.. Policy No. '' ` .Company --
❑Copy-is,filed with the city.. O Certified copy is hereby furnished.
TOTAL
I E.18637
- CERTIFICATE OF EXEMPTION FROM . '
REMARKS
- WORKERS' COMPENSATION INSURANCE 1
• (This section need not be completed. if the. permit is for one hundred dollars -($100) valuation.-
- ,.h!>';641':!,-f.n � ,...,d ,,,,,(^j-.. �.-r', .,.2;;. _
or less.)
I certify thafin'9he performance of thg work for which this permit is issued, I shall not
� �
, .
��:� . TAM
A Ju.
• 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' Compensation 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
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
{ .R
. 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 1 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
r -
Mailing Address
.."Validation:•
City, State, Zip
•.
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y f'tt. • ^�1I3'.i .. .�.i;4 l I�•n :r .. k'S `.5,•\ .
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT.
WALL SQ. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
AS (ROUGH)/.�� G�
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. ®c
BATH TUB
EINAL INSP.- 0%
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION[
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE LPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
ROUND PLUM /.!��"%
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
WER OR S G ltge
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
AS (ROUGH)/.�� G�
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
> �i INF. STS
-��REINF. STECL /U—� — �/U
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR,
EINAL INSP.- 0%
FRAMINGJ e�
FINAL INSP.
n
OOFING—// -,7 -
,/Y -RROOFING / / I -�
iJ j
f�J /
_. [ f �C1�l
L Lb°
REMARKS:
VENTILATION[
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING q-qgwc-
MESH
471
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL