002409 (BLCK)Bddr ss _06 a�
Address
Owner
VAW CVMC DevelOPMMt
Mailing
Address 51,625 . _M**Jm�_ Drive
City Zip Tel.
Contractor
Address
P.O. BOX 1504 NO ; ;
78-105 CALLE ESTADO . .
09
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 794-055-004
Legal Description TZt 4
Project Description
Date Owner
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 (5100) valuation
or less.) .. ..
1 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 ' Owner
NOTICE TO APPLICANT., 11, alter making this Certificate o1 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 it work thereunder is suspended for 180 days.
I certify that I have read this•application and state thar,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 f -yam- L l 'Date
Mailing Address
City, State, Zip
HARD COPY
Infrastructure
TOTAL
REMARKS
ZONE:
BY:
Minimum Setback Distances:
. City.
r ip ....Tela
.600
Rear Setback from Re.ar.P..rop..Line
State Lic.
& Classif.
City
Lic. #
Sq. Ft. No.
Size 100 • - ftStories•
No. Dw.
-Units
' Arch., Engr.
' Designer
New Ca Add ❑ Alter ❑
Repair ❑.. 'Demolition ❑
Address
Tel.
Validation:
City
Zip
State
Lia #
1_ >?W-* Mftb V.P+afnina
1AII
_ LICENSED CONTRACTOR'S DECLARATION
I hereby 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.
- W
SIGNATURE r -" _ DATE
OWNER -BUILDER DECLARATION
I 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, 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 or the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Busines's and Professions Code, or that. he is exempt therefrom, and the basis .
for the alleged exemption. Any violation of Section 703h5 by 'any -applicant- for permit
subjects the'applicant,to a civil penalty of not more -than five hundred dollars ($500).
O I, as owner oftheproperty, or my employees with wages as their sole compensation; will
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 applyao 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 is 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.)
❑ 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 of 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. 8 P.C. for this reason
Estimated Valuation
.,I 'win ai
- PERMITAMOUNT -
... '
Plan Chk. Dep. - -
Plan. Chk. Bal. �s�C
Const. . ^ ^�
baSiJ
Mech.
. ,
Electrical - -
-Plumbing
_
S.M.I.
--
-
Grading
Driveway Enc.
Date Owner
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 (5100) valuation
or less.) .. ..
1 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 ' Owner
NOTICE TO APPLICANT., 11, alter making this Certificate o1 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 it work thereunder is suspended for 180 days.
I certify that I have read this•application and state thar,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 f -yam- L l 'Date
Mailing Address
City, State, Zip
HARD COPY
Infrastructure
TOTAL
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Re.ar.P..rop..Line
Side Street Setback from.Center Line
Side Setback from„Property Line
FINAL DATE
INSPECTOR
Issued by:
Date A-1 t—pr%Permit
Validated by:
Validation:
-A 5.778
6 11 4175 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. Fr.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SO. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOB]LEHOME 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
C/
T
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
OND BEAM 6 L
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
IVECH.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. 7
/
7'+•C•'REINF.
C/
T
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
OND BEAM 6 L
�/�
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
DEC
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