11714 (RPL)44 CQ
P.O. BOX 1504
Building 78.105 CALLE ESTADO
Address 62--300 Ramirez. LA QUINTA, CALIFORNIA 92253
Owner
Tnm � �tte.t:�t Tctl,c�s
a
Address 48_1¢0 Beverly Dr.
City Zip Tel.
'Pair Desert, Ck 0-2260 1 346-7767
Contractor
Ad
jZip I Tel.:
& i%
State Lic
rte^ 1 �Y '' I City
7 �-' Lic. #
Arch; Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S, DECLARATION'
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Sect Ion -
7000) of Divislon 3 of the Business and Professions Code, and my license is in full force and
effect.
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,Buslness 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 permlLto file 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 to a civil penalty'of not more than five hundred dollars ($500): ' •- '
❑ 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
or Improvement Is sold within one year of completion, theowner-bullder will have the burden
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-
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 contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
a
Date owner'
WORKERS' COMPENSATION DECLARATION
I hereby affirm that.l 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
❑ Copy Is filed with the -city. ❑ Certifled.copy Is hereby furnished.
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 anyparson In any manner so as to become subject to the Workers' Compensation'
Laws of Californla.
Date Owrier
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:
CONSTRUCTION LENDING AGENCY '
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit Is Issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
- This is a building permit when properly filled out, signed and validated, and Is subject to
expiration If work thereunderis 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.
Signature of applicant Date
Mailing Address
City, State, Zip
No. 11714
BUILDING: TYPE CONST. OCC. GRP.•
A.P. Number
Legal Description
Project Description Pool
Sq: Ft:"' ' NO.- No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
If %lkl%/L%t AiJ P,
stimated Valuation
•$8, 000.00
PERMIT
AMOUNT
Plan-Chk. Dep.
Plan Chk. Bal.
64.35 .
Const.
99 t oo
Mech.-
24.00
Electrical.
45.00
Plumbing
27.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
260.15
REMARKS
,1,.��.a s y5y ./ni ' t}t()�lyyty'�*f�pd'•.4,e.'�}' "1":a• • }�^ A :;
ZONE: BY:
-Minimum Setback Distances:
Front_Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES `
1ST FL. 'SQ. FT. $
UNITS
COLL. AREA
2ND FL. SQ. FT.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®
DUCT WORK
DRAINAGE PIPING
WALL SO. FT. ®
DRINKING FOUNTAIN.
SO. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
GROUT
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GRADING.
CU. yd.
$ -plus-x$_
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INS / G
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 ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3Vac
HOUSE SEWER
GAR. FIREWALL
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 aCS y3G
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--
TORAGEFOUND.
FOUND.REINF.
GAS (ROUGH) / L
v�
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.
FINAL INSP.l { (/13
FRAMING
FINAL INS / G
ROOFING
D
��(✓ 6 ? Zd I e"v
2
2
REMARKS:
VENTILATIONJ
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION q` 5 Ll
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL