08069 (RPL)0) �f
Building
Address 12-0.1
Owner • .
P.O. BOX 1504 N o . 080-69
78-105 CALLE ESTADO '
Velawo LA QUINTA, CALIFORNIA .92253
Mailing
Address.V 1asen
City Zip
� A EQFZ 41
Contractor •
AririrPcc ..
City
Costa's
State Lic: -
& Classif.l
Arch., Engr.,
"Designer,
Address
Zip
92626
Tel.
BUILDING: TYPE CONST. OCC: GRP.,
A.P. Number 77224-012
Legal Description
Project Description Pool
Lic. # Sq. Ft. No.
`x •Size • Stories
Tel.
New ❑ Add ❑ Alter ❑
No. Dw.
Units
Repair • ❑ Demolition ❑
CityZip
State
�-
Lic. #
LICENSED CONTRACTOR'S DECLARATION
Ihereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
r
_
SIGNATURE DATE
OWNER -BUILDER DECLARATION
�I hereby affirm that.l am exempt from the Contractor's License Law for the following
Estimated Valuation
' 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
'requires the.applieant.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:,Eep.
-
subjects the applicantto a civil penalty of not more than five hundred dollars (S500).
my y'
• Plan Chk. Bal.
_ '
- - 1 AFL
❑ I, as owner. of the property, or employees with wages as their sole compensation,. will
do the work, and the'structure is not intended or offered for sale. (Sec. 7044, Buisnes"s""and
Const.' -
- "
--5_
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 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
EI2CtrICdl
_
of proving that he did not build or improve for the purpose of sale.)
-0 I, asowner 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 of property who builds or improves thereon, and" who contracts for
S.M.I.
_, • '
such projects with a contractor(s) licensed pursuant to the CoMtActor's1icense Law.) -
i t X. >
❑ I *
Grading
,
am exempt under.Sec. B. & P.C�for this reason
Driveway Enc.
Date owner ►' �i iI11. A,
Infrastructure.
r1r, Lk 011101A
' WORKERS' COMPENSATION DECLARATION
I hereby affirm that,l 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.)
TRANK X64
Policy No. Company
❑ Copy is filedwith the city. ❑ Certified copy is hereby furnished.
'
TOTAL
CERTIFICATE OF EXEMPTION FROM . '
REMARKS
WO R K ERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one, hundred dollars (S100) 'valuation
r
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. -
Date Owner
NOTICETO 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.)
w
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.
S
I certify.that I have read this application and state that the above information is correct.
Issued by:
Date DIIQ 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-.
- -•
mentioned property for inspection purposes.
Validated' by:
Signature of applicant Date'
Mailing Address
Validation:
City, State, Zip
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. S0. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SO, FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
DRAINAGE PIPING
CAR P. SO. FT. ®
GAS (ROUGH)
METER LOOP
WALL S0. FT.
HEATING (FINAL)
DRINKING FOUNTAIN.
SO FT ®
GAS (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER HEATER
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
cu. yd.
plus x$
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, TEMIPERM
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 ® 11/4 c
SEWAGE DISPOSAL
SPARK ARRESTOR
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAR. FIREWALL
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
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
=$
LUMBER GR.
jNAL INSP. /(. 0
c�
FRAMING
FINAL INSP.
ROOFING
/ llr
tl,�L!i'/0/w
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES;INITIALS
GARDEN WALL FINAL