9877 (BLCK)P.O. BOX 1504 No. 9877
Building 78-105 CALLE ESTADO
Address 50•-905" Paloma LA QUINTA, CALIFORNIA 92253"
Owner
A F,: PSI Builders
Mailing BUILDING: TYPE CONST. OCC. GRP.
Address P. 0. Box 366
A.P. Number
City Zip Tel.
La Quiuta 92653 564--4832 Legal Description
Contractor Project Description
Sai`10
Address
1801 of 61—slump stone %aall
'City Zip Tel.:
State Lic. City
& Classif. 487584 Lic. # 626 Sq. Ft. No: No. Dw.
Size Stories Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolitiori ❑
Address Tel.
CityZip State
Lic. #
LICENSED CONTRA CTOR'S DECLARATION
I hereby affirm that I am licensed under p owsions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Pro essibns Code, End my license is in full force and
effect. ,/ _+ n
SIGNATURE I" DATE
OWNER -BUILDER DECLARATION Estimated Valuation ' (►
Thereby affirm that I am exempt from the Contractor's License Law for the following j�c�®6l a fl�
reason: (Sec. 7031.5,Business' and Professions - Code: Any city or county which requires a
permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant Ior such permit to file a sfgned statement that he fs licensed pursuant to PERMIT AMOUNT
Me• provislons tof: the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Divtslon 3 0l the4Busmess and Professions Code, or that.he is exempt therefrom, .and the basis
-
/or(tAe.alleged*�exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects"the, applicant to a civil penalty of not more than rive hundred dollars.($500).
O 1, 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. -72.00
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, MBCh.
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 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 e
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.Ucense Law.)
Grading
0 1 am exempt under Sec. S. & P.C. for this reason
Driveway Enc.
Date Ownet J Infrastructure
. — e
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to seUnsure, or A certificate of
Worker's Compensation Insurance, or a certified copyfthereof. (Sec. 3800-L%Wi Code-)
Por1cy No. Company [ �� ---��J
O Copy is filed with the city. 0 Certified copy is ereby furnished.
TOTAL 72.5-00
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.) ill1:�'t ` jt i.I { L..3 i� i s ; 7757-
1
1 certify that in the performance of lhg 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
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
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 it 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
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEETS•.1
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ, FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SQ. FT.
ROCK STORAGE
DRAINAGE PIPING
WALL SQ. FT.
GAS (ROUGH)
DRINKING FOUNTAIN.
SQ FT ®
OTHER APPJEOUIP.
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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
=$
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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
SO. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® IV/s c
SEWAGE DISPOSAL
SQ.Fr.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 0A
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 ^ (0
I.
vl� ��
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
/
co
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION- Ot l a q'
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL