10618 (BLCK)'� 78-501 $A6Ps8Rt3SH ItiVI
78-595 SAGEBPtiiBH
(:il? 44a
Cf 78545 SAGEBRUSH P.O. BOX 1504
Building 78-105 CALLE ESTADO
Aritirpcs LA QUINTA, CALIFORNIA 92253
Owner I
BOB GRIMES
Malting
Address78--,385 EVENING STAR CIRCLE
City Zip Tel. I d
INDIAN WELTS 92270
Contractor
el.:
BUILDING: TYPE CONST
A.P. Number
Legal Description
Project Description
BLOCK WALL
I o Coco
No. 10618
OCC: GRP.
State Lic.
City
& Classif.
Lic. #
Sq. Ft.
No. No. Dw..
Size
Stories Units
Arch., Engr.,
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
70o 00) Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
_1;hereby affirm that I am exempt from the Contractor's License Law for the following
6�y
S 14=625. 00 -
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, atter, improve, .demolish, or repair any structure, prior to Its Issuance also
requires the applicant for such permit to rile 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, or that. he Is exempt therefrom, and the basis
for the Any Section 7031.5 by 'any for
Plan Chk.. Dep.
alleged exemption: violation of applicant a permit
' sul6/acts the applicant to a civil penalty of not more than five hundred dollars ($500).
❑If owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Bal.
do the work, and.the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
$ 152.00
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 offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
Electrical
'
or proving that he did not build or improve for the purpose of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
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. -
- 1 50
- such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)-
t§
Grading
❑ I am exempt Sec. t B. 8 P.C. for this reason
p
-
r .. �.
Driveway Enc.
Date ?^' �)' 4O6ner i F $ 3 I 1 l a�.F
Infrastructure
WORKERS' COMPENSATION DECLARATION
thereby affirm that I have a certificate of consent to self -insure, 'or a certificate of
ke
Worr's.Compensation Insurance, or a certified copy.thereof. (Sec. 3800, Labor Code.),.
�aEit x ^. 4A "ip7t iK, yy _t�•,,
Policy No. Company
f7/kCopy is filed with the city. ❑ Certified copy is hereby furnished.
f 4, �,� -•,
r
.'TOTAL
`� 03. 510
CERTIFICATE OF EXEMPTION FROM —
REMARKS
!
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hundred dollars ($100) valuation
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. If, 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 shall be deemed revoked.
Minimum Setback Distances:
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 purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Front Setback frorm.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 Permit
Validated bv:
Validation:
F
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT. ®
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
FORMS
1
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®
OTHER APPJEOUIP.
DRAINAGE PIPING
WALL SO. FT. ®
TEMP. POLE
DRINKING FOUNTAIN.
SO. FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
BOND BEAM
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
LUMBER GR.
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
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
MESH
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Yac
HOUSE SEWER
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 SIGNATURESIINITIALS
GARDEN WALL FINAL