9920 (PLBG)Building 51-745 TERMUDAS
•QUM. -.
P.O. BOX 1504 C-. r N o .
78-105 CALLS ESTADO 2sLA QUINTA, CALIFORNIA 92253
MICHAEL CLEMENS
Mailing
Address 51-745 BERMtTDAS
City
Zip
Tel.
LA QUINT®
1 92253
1564-
Contractor
. MERCIER DEO.
Address
2358 AURORA
City
Zip
Tel.:
PALM SPRING'
322-3096
State Lic.
City
& Classif. 413223
Lic. # 1721
Arch., Engr.,
Designer
Address
Tel.
CityI Zip I State
Lic. #
i Lf LICENSEWCONTRACTOR'S DECLARATION
ebb affirm that I am license?under provisions of Chapter 9 (c(
of Division(3rdf the Business and Professions Code, and my Iii
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
the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the'Susiness 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
X
the applicant to a civil penalty or not more than five hundred dollars.($500).
I, as owner of the property, or my employees with wages as their sole compensation, will
- 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.
orimprovement is sold within one year or completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose or sale.)
❑ 1, 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 or property who builds or improves thereon, and .who contracts for -
such projects with a contractor(s) licensed ursruariPto the�Contractor's License Law.) -
❑ 1 am exempt under Sec. ' B? 8 P. C.
for this reason
Date Owner1iv
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
_Copy is filed.with the city. ❑ Certified copy is hereby furnished.
i CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE.
(This section need not be completed if the permit is for one hundred dollars (8100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, 1 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. -
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 -.s
mentioned property for Inspection purposes.
Signature of applicant Date
Mailing, Address
City, State, Zip
9920
BUILDING: TYPE CONST. GAS OCC: GRP.
A.P. Number
Legal Description
Project Description GAS LINE — 100' FROM METER
XXONG SIDE OF HORSE
.•r'"
Sq. Ft: No. NO. DW.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chi. Dep.
Plan Chk. Bal.
Const. , 30.00
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL $30.00
REMARKS MSS
An
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. ® E
UNITS
COLL. AREA
2ND FL SQ. FT.
YARD SPKLR SYSTEM
POR. SQ. FT. @MOBILEHOME
SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®
DUCT WORK
DRAINAGE PIPING
WALL SO. FT.
DRINKING FOUNTAIN.
SQ FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ plus X$
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
FIREPLACE
SO.FT.GAR ® V/ec
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) (f R�
AXMETER LOOP
HEATING (FINAL)
OTHER APPlEOUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION-
NSPECTION
CERT.
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL