002539 (BLCK)Building
Address 78-670 fiac:rraw
Ri cat- J&msm
Mailing
Address P. 0. E= 2.2
City Zip: 9
Tl2` 02'".iss
Contractor
Address
City Zip
Indio 92202
State Lic:
& Classif. 397169
' Arch., Engr.,
Designer
~ Address
P.O. BOX 1504 NO.
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP..'
A. P. Number
Legal Description
Project Description "rm Z lon- y High L
Tela 564-2223
City
Lic. # 202
Tel.
City Zip State
.. - Lic:•#
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm. that l am.licensed under provisions�f Chapter 9'(commencIng with Section
7000) of Division 3 of the Business and, Professions Code, and my license is in full force'and
.effect �.4 �`r ��s' ` : e �.. '
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 ifs 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 penaltyof 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 Contractor's License Law does not, apply. io.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.
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-
struct 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
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
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑` Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
Plan Chk: -Dep.
Plan Chk. Bal.
Const..,
Mech.
Electrical
Plumbing
S.M:I. .
Grading
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
Ihereby affirm that I have a certificate of* consent to -self -insure, or a certificateof-
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
-Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATIONINSURANCE
(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 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
AMOUNT
31000
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 -
Setback
Distances:
comply with such provisions or this permit shall be deemed revoked. -
Minimum
-
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
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 ,
agree to comply with all city and county ordinances 'and istate laws relating to building
construction, and hereby authorize representatives ofFdhis city to enter the above-.
mentioned property for inspection purposes. ` r'
Validated by:
Signature of applicanf. / 7r= f �d�/ J : Date '✓ ` `_✓
Mailing Address
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FE&*
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT, ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
GAS (ROUGH)
DRINKING FOUNTAIN
SQ FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE. UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ plus x$
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.
SO. FT. ® c
BATH TUB
SO. 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
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
Z' I(FOUND. REINF. Q"" —�
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
ylK REINF. STEEL I
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM —OLS T
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR,
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
pp
D,EC 17—Vo
'
REMARKS:
VENTILATION
r
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
%,FINAL INSPECTION 6a
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL