05521 (RPL)P.O. BOX 1504 '
Building
Address 55-661 Pinehurst LA QUINTA, CALIFORNIA 92253
Owner
W.
/Mrs.. FrOW111
Mailing '
Address Same
City Zip Tel.
.Fa.'ditto 923531.619/346-1219
Contractor
20th Century rot}'! s
Address. 577 Suvmy Mums Rd., #11
Pala springs IZ'P92262 IT&.19%320-0688
State Lic. City
& Classif. 426-476'---`' C-53 Lic. #
Arch., Engr.,
Designer Hacker Engluwring
Address 4501 H. Spy ITt es Tel
City Zip State
Palm Spr- ngs 92262 Lic. # RCO--14614
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l.aA licensed;under provisions of Chapter 9 (commencing with Section
=Of
Division 3 qf #4,13u:`me.§s apFnd�jProffy�}e�'s�sions Code, and my license is irVull force and
31.\?.ti `
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5.8usbess and Professions Code: Any city or county which requires a
Permit to contra[. after, unprove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to We a signed statement that he is licensed pursuant to
the provisions of the Contractors 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 cin? 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 Contractors License Law does not apply to an owner of property who
builds or irnproves thereon and who does such work himself or through his own employees,
provided 'that' such kriprovements are not intended or offered for sale. lf, however, the building
of improvement is sold within one year of completion,. the owner -builder will have the burden
of provbg that he did not build or Improve for the purpose of 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 of property who brills 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
Date Owner
WORKERS' COMPENSATION DECLARATION
1 herebyrtificate of consent {o self -insure, or a certificate of
Workaffirm that I have a certificate
ers Compensation Insurance, or a certified�copji thereof. (Sec. 3800, Labor Code.)
Policy No Company :.,•"! b; s
❑ Copy is filed with the city. ❑ 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
Lawsof Calilperson in arty manner so as to become subject to the Workers' Compensation
ornia
Date owner
NOTICE TO APPLICANT: N, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions or the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 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.)
Lenders Name
Lenders 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 1 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
No. 05521
JILDING: TYPE CONST. Sgt'' OCC: GRP.
P. Number P.G. . $T '
Description
Project Description SPA
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑'. Alter ❑ Repair ❑ Demolition ❑
stimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
7
3
Const
.15
1 .0
Mech.
u
, U (31
Electrical
7,10
. `O
Plumbing
27.00
0
S.M.L..
. ru
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center.Line
Rear Setback from Rear Prop. Line
1 Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date 3%15/39 Permit
Validated by:
Validation:
CONSTRUCTION{ ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
I 1POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL' SQ. FT.
=$
LUMBER GR.
FINAL INSP.
URINAL
SQ. FT. @
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIREPLACE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
CERT. OCC.
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
REMARKS:
VENTILATION
FIRE ZONE. ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL
I