002307 (RR)Building
Address
4P.
O. BOX 150478-105 ALLE ESTADO 0051307
NO.
74-496 Celle Se&n4 LA QUINTACCALIFORNIA 92253
Mailing
Address
City Zip Tel.
ca CAinta '92253
Contractor
x ot5m c==v
Address.. . . .: .
BUILDING: TYPE CONST. - OCC'.-GRP.-
A.P.
CC: GRP.•A.P. Number
Legal Description
Project Description
City -
Zip ..
Tela
Indio
9224.
342-1141
State Lic.
City
& Classif.
Lic. #
Sq. Ft.
Size
No. No. Dw.
Stories Units
Arch'., Engr:;
Designer
New QA 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
7000) of Div'"sion 3 of the Business and Professions Code, and my'license is in full force and
effect.. l
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-
- _ • -
SIGNATURE '�-<.•'" ' •i -••a` DATE
/y OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's. License Law for'Ahe following.
Estimated Valuation .
� �
reason: (Sec. 7031,5,Bus1ness 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
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
-
0
-' -
•' -PERMIT
' AMOUNT
'
' Division 3 o/'the' Business' and Pro/essions Code, or'that. he Is exempt ' therefrom, and the (iasis-
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant /or a -.permit
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. Dep..
Plan Chk. Bal.
Const.'
'
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 to an owner of property who
Mech.
'
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are,not intended oro/fared for sale. If, however, the building _.
•Electrical •-
or Improvement is sold within one year o/ completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.) _
Plumbing
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code:, The Contractor's License Law
does not apply to an owner o/ property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. B. ti P.C. for this reason
_
S.M.I.
Grading
-
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
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 No. Company
❑ Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL
93 n
REMARKS
CERTIFICATE OF EXEMPTION FROM 1`
WORKERS' COMPENSATION INSURANCE .. .
(This section need not be completed i/ 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_LOwner'
,NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions o/ the -Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.'
ZONE: BY:
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
FINAL DATE
INSPECTOR
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.
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 in purposes.
ISSued'by:
Validated by:
Date Permit
Signature of applicantf % /r •. Date 7 ��
Mailing Address A-
Validation:
A5273
4 17 2100 CK
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. p
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. ® c
BATH TUB
SQ. 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
REMARKS:
VENTILATION
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 APP.IEQUIP.
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 iI ]�/+.�(n
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 :d