08915 (RPL)L.
Building
Address 72--28 Sand
Owner -
Mailing
Address
City
LA • Oninta
Contractor
C AT.I V
Address • • .
Zip
City IZip
D>m"?s4eYt
State Ljc:.l
& Classif:.. I$5 ji2
' Arch., Engr., • -
Designer
Address
City F, Zip
I hereby
7000) of L
effect. '
EN
P.O. BOX 1504 No. 08915.----..
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING- TYP 11 OCC: GRP.
A.P. Number '
Tel. _
3«.696Legal Description
Project Description 1 III, it 7 SO- rowal .1 A { "� C>:► a
1r. .Q (A-3).. '..o 36 T
�.
.. _A
e .,
340-9000
City
Lic. # - Sq. Ft: No. No. Dw.
Size - Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ .Demolition -0
State
Lic. #
DECLARATION '
of Chapter 9 (comme
'ode, and my license
OWNER -BUILDER DECLARATION ' • J
rith Section ': '
II force and
Ihereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation - 1I tR! ,
- 0.0®•
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
s� V0�_•"- �<
the
requires e applicant for such permit to file 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
E
Division 3 of the Business and Professions Code; or that.he is exempt therefrom, and the basis
for the Any Section 7031.5 'any
.a.; . , - •' -i
Plan Chk. Dep.
alleged exemption. violation of by applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (8500)..
Plan Chk. Bal.
IDA, 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
COr1St
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 thatsuchimprovements 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
of 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 or property who builds or improves thereon, and who contracts for
S. M.1. •�•
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
84,
Grading
❑ I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
,
hereby 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. 3600, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
•TOTAL
,
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.) ..
, .. ,.. .j, ,r -Y)•,• ,(�
I certify that in the performance of thg work for which this permit is issued, I shall not
¢¢_�,,,,,,w �Kc �
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you 'should become
ZONE: - BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
_
Minimum Setback Distances: '
Front Setback from Center Line
_
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Side Setback from Property Line'
Lender's Name
'
Lender's Address
FINAL DATE INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
-
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
'
Issued by: Date Permit
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof this city to enter the above-.
t
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date
Mailing Address a.
Validation:
City, State, Zip
t1 ,. .�� - 1: r: �. '• � �,.t �. --.:. y :.f t;. -z i y Y
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t s ..rl'',
- `i`.+yi:Y" i"'Y.. `s, ^a ix
.$ � N ,�•:.� . fes.. .i•� . r yri... �.. _•Tari t',3. .- . - s.
.. i� ;� , r ...r �1.. � _ .,.f •. �f _. t. _ ter. Cf tom.- a. �' :v:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. I SO. FT.
WALL SO. FT.
SO 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
SLAB GRADE`Ad
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SEWER OR SEPTIC TANK ROUGH WIRING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROCK STORAGE
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAS(ROUGH
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
WATER HEATER
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/.c
HOUSE SEWER
f46 1-0cu.
GRADING
yd.
$ —Plus—X$—=$
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE IPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBIN
UNDERGROUND-//N/?,
��
A.C. UNIT
COLL. AREA
SLAB GRADE`Ad
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS(ROUGH
4 Lb METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.�� (
FINAL INSP./((
%Q/�
f46 1-0cu.
GRADING
yd.
$ —Plus—X$—=$
LUMBER GR.
FRAMING
ROOFING
1 ` e�a fi 0
rid �� L�
1 [
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION l l Q
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL