002735 (RPL)4 4XP
P.O. BOX 1504 No. 002735
Building78-105 CALLE ESTADO
Address 55-700 Pinehurst LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. OCC: GRP.
Mailing'
Address--�'ii� �rc3 Mob DK"i'vz-
A.P. Number
City
Zip Tel.
Palm -Desert
922£0 %8`2828
Legal Description
Project Description
Contractor.
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Address ..
pool
City -
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Zip
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Tel.
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State Lic.
& Classif. % a� •�% rJ f
City
Lic. #3gW,�
Sq. Ft.
Size -
No. No. Dw.
Stories - Units
...Arch., Engr., .
Designer
New O� Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
L-ic. # -
LICENSED CONTRACTOR'S DECLARATION
- I hereby affirm that I.amlicensed unde jprovisionstof_pt'apter g.(commencing with Section
7000) of Division 3.0f the Bus-iness,an`d'Profession"s Codefid my license is in full force and
effect.- . �s PrP'
SIGNATURE "" DATE
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 of the Contractor's 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' civil penalty of not more than rive hundred dollars'(S500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
Estimated Valuation
/�R
q/� Vi9�s6l47
PERMITAMOUNT
'
Plan Chk. Dep.
_
Plan Chk.. Bal.
a 32
Const.
•
1 x_56
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
proving.thal he did not build or improve for the purpose of sale.) ..-
Mech.
ii.{i�i
-
Electrical
W11 -M)
Plumbing
14 -tits
❑ I, as owner of the property, am exclusively contracting with -licensed contractors to con-
strucl the project. (Sec. 7044, Business and Professions Coder The Contractor's License Law;,..
does not apply to an owner of property who builds or improves thereon, and who contracts for
S. M.
• such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
.. ❑ I am exempt under Sec. B. & P.C. for this reason
Grading
-
Driveway Enc.
Date owner
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. Companyy
❑ Copy is filed with the city. ❑ Certified copy is.hereby furnished.
293.19
G
TOTAL
REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S100) valuation
or less.) '
certify that in the performance of thg 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.
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 there 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
Issued by:
Validated by:
Validation:
INSPECTOR
Date Permit .
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 lawsrrelating to building
.construction, and hereby authorize representatives sof this+ city to enter dhe above-
mentioned property for inspection"purpose6s.
Signature of applicant
Mailing Address
City, State, Zip
A6844
12 3 183.1 9 161
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT.® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ, FT. ®
CAR P. SQ. FT.
WALLSQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
REMARKS:
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)
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
1 UM'J WUNA 1 UKLWINI I IAL1,
GARDEN WALL FINAL