15127 (SOTB). 1
P.O. BOX 1504 N o . 1512?
Building 78-495 CALLE TAMPICO .
Address 78-736 Highway 111 LA QUINTA, CALIFORNIA 92253
Address ,
CityZip Tel.
. 1
Contractor
OirBuilders
Address
City Zip Tel.:
' Palm Desert 92211 350-5032
State Lic. City
& Classif:B 693077 Lic. #
Arch:; Engr.,
Designer
Address Tel.
City Zip State
t Lic. #
dad
LICENSED CONTRACT.OR'S.DECLARATION
I heAof1Wr9io-n'j3r,of
airm that I am licensed under provisions of Chapter 9 (commencing with Section*
7000) the Business and Professions Code, and my license is in full force and
eff
SIGNATURE ' - 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, -after, 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 _
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
subjects the applicant'(o a civil penalty of not more than rive hundred dollars ($500).
.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
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, }
provided that such -improvements are not intended or offered for sale. If, however, the building"
BUILDING: TYPE CONST. OCC. -GRP..
A.P. Number
Legal Description
Project Description Tread enclosure
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation_
PERMIT AMOUNT
Plan Chk. Dep. ,
Plan Chk. Bal.
Const. 45.00
Mech. '
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.)
'
0 I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
siruct 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
M. I.
such projects with contractors) flcensed pursuant to the Contractor's License Law.)
Grading
O I am exempt under -Sec B. 8 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
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code:)
Policy o. - Company
Copy is filed with the city, ❑ Certified copy is hereby furnished.
TOTAL
45.00
CERTIFICATE OF EXEMPTION FROM
REMARKS.
WORKERS' COMPENSATION INSURANCE
(This section need notbe completed If the permit is for one hundred. dollars ($100) valuation
'
' or less.)
I certify that in the performance of thg 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 LOwner
NOTICE TO APPLICANT: d, 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
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 Is a building permit when properly filled out, signed and validated, and. is subject to
FINAL DATE
INSPECTOR
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..
for
Q
mentioned property inspection purposes.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
MAYO 6 199b-
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
FOR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. F7.
GAS (ROUGH)
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.000L 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, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ®c
IWATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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 GOND. 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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP. _
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
;g;A7L INSPECTION �?
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL