10952 (BLCK)Ax illoe
P.O. BOX 1504
No. 10952
Building 78-105 CALLE ESTADO
Address n77-535 Sagebrush LA QUINTA, CALIFORNIA 92253
Owner
Bob Grimes
MailingBUILDING: -TYPE CONST. ' OCC: GRP.
Address 77385 Even -Ing Star
A.P. Number
City Zip �aa Tel. ,
,•W• 922 772-0908 Legal.Description
Contractor / i d Project Description
Owner Bu_� der
of 61 blOCii wall
Address
City Zip Tel.:
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch.; Engr., •
Size • Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70(X1) of Division 3 of the Business and Professions Code, and my license -is in full force and
effect.: ..
SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirlm that I am exempt from, the Contractors License Law for the following625
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a C
permit to construct, alter, improve, demolish, or, repair any structure, prior to its issuance also AMOUNT
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to PERMIT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
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 vprxant for a permit Plan Chk:.Dep.
sutrjects the applicant to a civil penalty of nor more ishan -five hundred dollars (S500). plan Chk. Bal.
C;, 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. 1 • J
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, Mech.
Provided that' such improvements are not intended or offeredfor sale: ff.. 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 com - Plumbing
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. • b!
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
0 I am exempt under Sec ! t B. B. P.C. for this reason Grading
Driveway Enc.
DateOwnec / S? -'�E +�1�V �r. Infrastructure
a
WORKERS' COMPENSATION DECLARATION
I hereby'affirm that'I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
PdlicyYNo Company a 7�
❑ Copy,is filed with the city. O Certified copy is hereby furnished.;% +
TOTAL 1 • b
CERTIFICATE OF EXEMPTION FROM REMARKS'
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars ($100). valuation
or less.) - -
I 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. ff, after making this Certificate of Exemption you should become .ZONE: BY:
subject to'the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shafl be deemed revoked. 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
Lenders Address "FINAL DATE INSPECTOR
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 Issued by: Date Permit'
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. Validated by:
Signature of applicant Date
Mailing Address Validation: .,
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
2ND FL. SO. FT. ®
SLAB GRADE
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®
SEWER OR SEPTIC TANK
DRAINAGE PIPING
WALL SO. FT. ®
DRINKING FOUNTAIN.
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
HEATING (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
REINF. STEEL
GAS (FINAL)
TEMP. POLE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
�a
LAUNDRYTRAY
AIR HANDLING UNIT CFM
GRADING
cu. yd.
$ plus
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 ® 11/4 c
SEWAGE DISPOSAL
FIRE ZONE ROOFING
SO.FT.GAR ® 3/ac
HOUSE SEWER
FIREPLACE
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEEONST.
CFEE 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 6
SEWER OR SEPTIC TANK
ROUGH WIRING,
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
r OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
�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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION 3/1qj 9,
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
.
GARDEN WALL FINAL