001944 (PLBG)TAh
Building 49-786 X �.I DriveAddress
Owner
Mailing
Address t
City lZip ITel
.. rA ouil1 92253
Contractor
Aaaress
P.O. Bac £65
j City' Zip
iduo 92202
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Tela
341—.3629
No. 001944
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Project Description '
. . - Pax'"r.,i al w re -p .
State Lic.
City
Minimum Setback Distances:
& Classif.����
Lic. #
Sq. Ft. No.
No. Dw.
Side Street Setback from.Center Line
Size • Stories
Units
Arch., Engr.,
INSPECTOR
Issued by:
i Designer
i
New 9 Add ❑ Alter ❑
Repair ❑ Demolition ❑
Address
Tel.
A3517
i2 10 1200 R
i City
Zip
State
Lic. # -.
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am 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
i effect. Y .. 1 It ,.a�i
:�•..f�1
SIGNATUREr - DATE
-
i OWNEWBUILDER DECLARATION
Estimated Valuation
j 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 lila a signed statement that he is licensed pursuant to
- PERMIT
- 'AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, of that. he is exempt therefrom, and the* basis
Any Section 7031.5
Plan Cihk.. Dep. -
•
for the alleged exemption. violation of .by any applicant -for a permit
subjects the applicant to a civil penalty of not more than live hundred dollars ($500).
•-
Plan Chk. Bal.
❑ 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
Const.
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,
Mech. '
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
Electrical
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-
Plumbing
12.00
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
S.M.I. -
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - -
Grading
11I am exempt under Sec. B. 8 P.C. for this reason
iDriveway
Enc.
Date Owner
I
Infrastructure
'
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
I ❑ Copy is filed with. the city. - .0 Certified copy is hereby furnished.
I
I 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.
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
mentioned property for inspection purpposes.
Signature of applicant -`�� '� " Date
Mailing Address ! `
City, State, Zip A
i
HARD COPY
TOTAL ".OU
REMARKS
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 124"= -Permit '
Validated by:
Validation:
A3517
i2 10 1200 R
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
Y
ARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SQ. FT. @
GAS (FINAL)
0
WALL SQ. FT.
DRINKING FOUNTAIN
SQ 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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL"
LATHING
SQ.Fi.GAR g 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 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 APP./EQUIP.
REINF. STEEL
GAS (FINAL)
0
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
DE , B(9 7 "
Aid
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 FINALE