08984 (RPL)P.O. BOX 1504 N o.
Building 78-105 CALLE ESTADO t J
Address 54-120 Avenida Ramirez LA QUINTA, CALIFORNIA 92253
Owner
Bryan Orr BUILDING: TYPE CONST. VL-inl OCC: GRP
Address
City lZip ITel.
Contractor I
S%=Ue Fools
Aaaress I
P.O. Box 12573
City lZip Tel.:
State Lic. City
& Classif. I Lic. #
Arch., Engr.i I
Designer
Address Tel.
City Zip State
Lic: #
`LICENSIED CONTRACTOR'S DECLARATION
I hereby affirm thatjrdm licensed under provisions of Chapter (commencing with Section
7000) of Division 3,of the Bus{nes and Professions Code, and my license is in full force and
effect• ya
OWN ER•BUILDER AECLARATION
I hereby affirm that.l am exempt from th6 Contractors 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
j 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 o 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).
''"-'O I, as owner of the property, or my employees with wages as their sole compensation,. will
E =:do the work, and the structure isnot intended or offered for sale. (Sec. 7044, Buisness and
n :,Professions Code: The Contractor's License Law does not apply to an owner of property who
!.•}•:.tiLilds or improves thereon and who does such work himself or through his.own employees,
•piovided 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
n ; of proving that he did not build or improve for the purpose of sale.) '
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.)
O 1 am exempt under Sec. B: & P.C. for this reason
Date Owner,
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 No. Company
O Copy is filed with the city. O Certified 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 ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not.
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
bate Owner
NOTICE. TO APPLICANT.% If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097,.Civil Code.) _
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
A.P. Number
Legal Description
Project DescriptionVOW.' QMT-.$
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add O Alter ❑ Repair ❑ 'Demolition ❑
Itsnmateo valuation S8500.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
70.20
Const..
10$..40
Mech.
.00
Electrical
30.00
Plumbing
21.00
S.M.I.'
Grading
Driveway Enc.
Infrastructure
TOTAL
b i3
REMARKS
:,�• ::-•o : - r :iea._ � �s..,�i sr#
:.A & S'1 1 "10�'t X 244 `E ,.,-
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
IST FL. SQ. FT. ® $
UNITS.
COLL. AREA
2ND FL. SO. FT.
ROUGH PLUMB.
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 SQ. FT.
GAS (ROUGH)
DRINKING FOUNTAIN.
SQ FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
plus x$
LAUNDRY TRAY
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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 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.
FINAL INSP.
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 SIGNATURESIINITIALS
GARDEN WALL FINAL