003056 (RPL)P.O. BOX 1504 No,. 003056
Building„ 78-105 CALLE ESTADO
Address 52-30-4 Avenida Raniez LA QUINTA, CALIFORNIA 92253
Mailing
-
OWN ER. BUILD ER,DECLARATION
*r
I hereby affirm that 1 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
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): _
❑ 1„as owner of the property, or my employees with wages as their sole compensation, will
Estimated Valuation
Address,
- PERMIT
-AMOUNT
'
Plan•Chk. Dep..
CityZip
Const,
Tel.
do Ile 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 .
Iwho;
La 4�atnta
52253 ..
...
564-4233
Contractor
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 or sale.)
Plumbing
Y
x
O 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.)
❑ I am exempt under Sec. B. & P.C. for.this reason
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SE nair Pols .
Grading
Address
Driveway Enc.
Date / f owns f
..
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City _
Zip
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Palm
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522.61
568-m4014
State Lic.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
City
& Classif.
C--53 353252
Lic. #
Arch En r
' 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. -
ZONE: BY:
Minimum Setback Distances: - '
9 •,
Designer
Address
City
Tel.
Zip State
�+ Lic. # -
CONTRACTOR'S DECLARATION
under provisions of Chapter 9 (commencing with Section
and Professions Code, and.my license is in full force and
Pt.. r
BUILDING: TYPE CONST: OCC: GRP..
A.P. Number 773--261-023•
Legal Description
Project Description �>.s'is%ilea"°litig Pdol
Sq. Ft. No.
Size Stories
New N' Add ❑ Alter ❑
No. Dw.
Units
Repair ❑ Demolition ❑
r .i /� e” _ 11 101_. 9d 1 �1/ `,r ti / .L -f ,/ t J T r f
SIGNATURE- - t r K ../ +DATE
-
OWN ER. BUILD ER,DECLARATION
*r
I hereby affirm that 1 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
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): _
❑ 1„as owner of the property, or my employees with wages as their sole compensation, will
Estimated Valuation
) s e�{3
- PERMIT
-AMOUNT
'
Plan•Chk. Dep..
Plan Chk. BBI.
Const,
o s3 11)
do Ile 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 .
Iwho;
.
McCh.
.
'
builds or improves thereon and 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
14.00 //r1 qqrryt
14lp • 0 V '
'
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 or sale.)
Plumbing
Y
x
O 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.)
❑ I am exempt under Sec. B. & P.C. for.this reason
�t
..
S,M.L_
Grading
Driveway Enc.
Date / f owns f
Infrastructure
/T1' WORKE�S' COMPENSATION DECLARATION. 4�.
4l Iii jeliy-affir'm that have a certificate of conseht to self -insure, ora certificate of
i Worrke`C�
s Compensation Insurance, or artified copy thereof. (Sec. 3800, Labor Code.)
j(Policy No: Company
❑ Copy is filed with the city. O Certified copy, is.hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.) ..
- I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person -in any manner so as to become subject to the Workers' Compensation'—
Laws of California.
' Date Owner'
NOTICE TO APPLICANT: If, after making this Certificate of -Exemption you should become:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. -
ZONE: BY:
Minimum Setback Distances: - '
F t S tb k'f
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify .that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of, this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
HARD COPY
ron a ac rom Center.Llne
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date 4/1 631$ Permit
Validated by:
Validation:
A7765 4 16 j-,)9.52 it
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEESNO.
PLUMBING FEES
IST FL. SQ. FT. ®$
2ND FL. SQ. FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. 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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
L
l /
(�
SQ.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
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
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
L
l /
(�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL