12082 (RR)`cv.
P.O. BOX 1504 No. 12€82
Building 78-105 CALLE ESTADO
Address 78-048 San TS.iCtotco LA QUINTA, CALIFORNIA -92253
F
Owner
Mailing
Ric .hard Mitchell BUILDING: TYPE CONST. OCC. GRP.
-
Address sante '
A.P. Number
CityZip Tel.
LA Oktzna.a 92253 -
Legal Description
Contractor Project Description Ref6of wi b. lightweight t 1 le
Nelsonlkoofing
Address, •-, r, �,
P.O. 'Box 584
City Zip Tela
Palm Vesext, Ca 92250 3141-9450 -
State Llc.City
& Classlf`-639 515729' Lic. #' � 1654 Sq.Ft. 7®�� No: No. Dw
Size . Stories - Units
Arch., Engr:�. - _ . .
Designer, New ❑ A'dd ❑ Alter ❑ Repair ❑ Demolitions❑
Address ,. ,r r...TeC , . ` ' „ . a•_ �.'
City f Zip State, r
`' Lic. #
:.
�• LICENSED CONTRACTOR'S DECLARATION '
I hereby.affirm that I am licensed under Provisions of Chapter 9 (commencing with Section '
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
;e fect. 't /+ - -
�C��--"«'t/'.lt�itF�;r•+.,,.••,�+.•., ^µ•:•Vi; _
_SIGNATURE DATE >37
OWNER -BUILDER DECLARATION
I hereb • affirm that I am exempt from the Contractors License Law for the following Estimated Valuation f1
Y Contractor's 9 ���/7i.•.QV ;.
reason: (Sec. 7031. S, Business and Professions Code: Any city or'county which requires a 4 f' { �+ •-
permit to construct," alter, improve, demolish, or repair any structure, 1priot to its issuance also - 3.
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT I 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 alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep: f. _
subjects the applicant to a civil 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 Plan Chk. Bal. ;
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. • 0-0Professions 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 Mech. --
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 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.
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading ;•
❑ 1 am exempt under,Sec. B. & P.C. for this reason
Driveway Enc.
Dateowner 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 Company
"No -
_.p is filed with the city. ❑ Certified copy is hereby furnished.. i
! TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation .. r4('tq.4t .I '$-Ls.
or less.) .`o'd°'" ""2•r'atK+`I'3 t '.f'EYr
I certify that in the performance of the work for which this permit is issued, I shall not x
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 Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. ,
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line c
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
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 Y
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. S0. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. S0. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
`
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
WALL SO. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
SO. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.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 V• = 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
�^
'fes
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION —
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL