003043 (BLCK)ArlddPn9 78-540 Battlebwah
T41At 4 4 Q"
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. 003043
i Owner
Side Street Setback from Center Line
A. Himagon
BUILDING: TYPE CONST.
OCC. GRP.
Mailing
Address 78-540 Mttlebx> lit
A._P. Number 617-381--047
Lender's Name
City Zip
Tel.
La Qt3tintAt 32253
-
Legal Description
Project Description
Carden Wall
Contractor
T. D. EixterDrisea
expiration it work thereunder is suspended for 180 days.
I certify that I have read this that Information
Address
191 Civic Drlvei #1--23
application and state the above -is correct.
I
Issued by:
City -
Palm Springs
Zip
92262
Tela
320!-3173
construction, and hereby authorize representatives -of this city to enter the above-
State Lic.
City
mentioned property for inspection purposes.
Validated by:
& Classif. 453816
Lic. # 77 %
Sq. Ft. 1000
Size
No. No. Dw.
Stories Units
• _
Arch., Engr.,
Designer
New OX Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
6' X 170
1020 so. Pt.
A7738
4 13 8382 fl
City
Zip
State
Lic. # ;
LICENSED CONTRACTOR'S DECLARATION,
I hereby affirm that I em licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect. f - .. i
.,
•_
SIGNATURE DATE
e OWNER•BUIL'DER 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 countywhich requires a
permit to construct,, after, 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 o the Business and Professions Code, or thathe is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by' anyapplicant 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, the owner -builder will have the burden
- of proving that he did not build or Improve for the purpose of sale.)
Estimated Valuation .
• • -PERMIT -
'
AMOUNT
Plan Chk. Dep.
•-
Plan Chk. Bal.
932.82
COnSt.��
51)
Mech.
Electrical
'
Plumbing
0 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
S. M.�()
Grading
Driveway Enc.
Date owner
Infrastructure
r 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.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it 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.
Date Owner
NOTICE TO APPLICANT., It, 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.
R
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
• CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
I hereby affirm that therd is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Side -Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
This is a building permit when properly filled out, signed arid validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this that Information
410 111*7 Permit
application and state the above -is correct.
I
Issued by:
Date
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.
Validated by:
Signature of applicant— Date
Melling Address.
Validation:
City, State, Zip
A7738
4 13 8382 fl
HARD COPY
'
T
--
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SO. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. Q. FT. ®
GAS (FINAL)
TEMP. POLE
WALL SO. FT. @
DRINKING FOUNTAIN
SO FT ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
CU. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
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 ® 11A c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
MESH
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 APP./EQUIP,
INF EEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
OND BEAM Ll `�G— a
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
I N SU LATIONISOUN D
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FFNr:F FINAI
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL A