9516 (RR)P.O. BOX 1504 ,V N 0. 9 516
Building
Address
78-467 C' ALLR SEAMA
7&105 CALLE ESTADO
' LA QUINTA; CALIFORNIA 92253 .
.• •
Owner
7
Lic. #
30.00 '
— 'v 1.
UR.
ROY STUSPH
DATE
R•
Mailing
Estimated Valuation
BUILDING: TYPE CONST — OCC: GRP.
Address .
P.O. SOB 1117
A.P. Number
�'7�P�'d ti
ri /Q e
City
Zip
Tel.
T
FINAL DATE'
La QuInta
Issued.by:
82253
L egal Description
-
Contractor
Project Description
Re_ rco£
A m0
ed •Ra0 r._
Address
�.
-Palm �Svrinaa 1 9
State Lic.
`& Classif. '471881 C-39
Arch., Engr.,
Designer.
Address
Tel.:
City r^.
Lic. # Sq. Ft. •No.'=
Size- .1400 • •Stories
Tel.
I New ❑ Add ❑ Alter ❑
City
Zip
State
ti
7
Lic. #
30.00 '
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
effec of D' II I� n:3 of the Business and Professions Code, and y license is in full force and '
DATE
R•
' OWNER -BUILDER DECLARATION
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, after,. improve, demolish, or repair any structure, . prior to its issuance also
requires the applicant for such permit to rile a signed statementthatheis licensed pursuant to
the provisions of the Contractor's License Law,. - Chapter 9 (commencing with Section 7000) of
Division 3of 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 penalty of not more than rive hundred dollars.($500). , t •
❑ 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. (Seca 7044, Buisness and
' 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,
provided that such improvements are not Intended or offered for sale. If, however; the building
or Improvement 1s 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.)
Estimated Valuation
-
.PERMIT
'
-
Plan Chk. Dep.
-
Plan Chk. Bal.
Const:
Mech. ,' • ,
Electrical
O 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,
Plumbing
• does not apply to an owner of property who builds or improves thereon, and who contracts for : S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
« Grading
O 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner 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 No: .Company -
❑.Copy Is filed with the city. ❑ Certified.copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE-.
(This section need not be completed If the permit Is for one hundred' dollars (S100) valuation
or less.) -
I certify that in the performance of the work for which this permit is issued; I shall not
employ anyparson 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
subject to the Workers'. Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
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 +'•
No. Dw. 1
Units -
Repair ❑ Demolition;❑•
AMOUNT
30.00
ti
7
TOTAL
30.00 '
REMARKS
AMOUNT
30.00
•
TOTAL
30.00 '
REMARKS
R•
ZONE:
BY:
Minimum Setback
Distances:
-Front Setback•from 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 by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT.'@
GAR. SQ. FT. ®
CAR P. I 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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+A c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.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 APPJEQUIP.
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 S 3 q t)REMARKS:
t
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION-
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL