07911 (BLCK)Building
Address 51-125 vetasca
Owner
Dot Lraves►t
Mailing „
Address 7A R+
City Zip
Contractor
OlViker
Address ':.•
C&tyl
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P.O. BOX 1504 N o . 07911
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253',. s
,.,; . BUILDING:- TYPE CONST. OCC: GRP. '
Y A.P. Number. 7J3..;�19A_nJC fit n3s •
Tel. �--•. . _ �—�-�
Legal Description 10t
Project Description Y inns ruining tan *�
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City :.t
Zip
Tela
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State Lic. - _ '
City
& Classif.
Lic. #
Sq. Ft.
No. No. Dw.
Size
Stories Units- .
Arch., Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ 'Demolition ❑
' Address
Tel.
CityZip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
-1 hereby affirm that I am licensed under provisions of Chapter (commencing with Section
7000) of Division 3 of the Bus)inessyand'Professions Code, and my license is in full force and
effect. ?AV i _; • F S� i {%�%
SIGNATURE DATE
' OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
$1 ��
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
*"2
requires the. 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
'
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:
subjects the applicant. to'a civil penalty of not more than five hundred dollars ($500).
Plan Chk. Bal.
,
❑ 1, as owner of the property., or my employees with.wages as their sole compensation, will
do the work, and the'slructure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.,
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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. lhat'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
• • `
ofAp vIn6 ths1he did not build or improve for the purpose of sale.) -
+•Yyp;l as.owner`of the property, am exclusively contracting with licensed contractors to con-
•
Plumbing
.• sGuct-the project..(Sec..17044,.Business and Professions Code: The Contractor's License Law
. does nor apply,lo: 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
❑ I 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.)
L _
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Policy No. .Company
• ❑ Copy is filed with the city. O Certified copy is hereby furnished.
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TOTALr
CERTIFICATE OF EXEMPTION FROM
REMARKS
^
'�^° R'W'^�";'.R
WORKERS' COMPENSATION INSURANCE
(This section need not be . completed if the permit is for one: hundred dollars ($100) valuation _
,p'
N 1r'Y4� �. a q,} q }'{'tr,. ,V 45.. 1
or less.) -
I certify that in the performance of the 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.
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NOTICE TOAPPLICANT.r 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
CONSTRUCTION LENDING AGENCY r
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
!-,"77-77-7717 -.7t 77 7 / l t -1
'•+, •f ; r. ti.� :ry n•�' .Y'• ","'-� , , .. - r.r
Rear Setback. from Reay Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date/17/Q�'3F ermit .
Validated by:
Validation:
4
-t' `svr' t• y :. , i M rt t"«'. -• i,.. `j .•`i ti +� !L G ..i ••!T .
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
A.C. UNIT
2ND FL. SQ. FT.
SLAB GRADE
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT.
ROUGH WIRING.
DRAINAGE PIPING
WALL SQ. FT.
ROCK STORAGE
DRINKING FOUNTAIN.
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
HEATING (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
GAS (FINAL)
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SERVICE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
Ak
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
FIRE ZONE ROOFING
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 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
Ak
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