12503 (PLBG)P.O. BOX 1504
Bui,Adcrdines9?-8 Calle 1�'ico LA QUINTA CALIFORNIA 92253
Richard Hill
Mai ing
Adc fess -51-383 Bermudas
Ci Quin a', C11
Zip 922'53 Ilei. 5641<-45 .3
t
Contractor
BarfT Plumbing
P.O. Box 1.255
V41% Desert, zi? 92261 ie1328-671.8
CitLic.
x &fClassif. C-36 310813 Licy# 82
Arch., Engr.,
Designer
Add -ess I Tel
City Zip State
Y d Lic. #
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�CENSEU CONTRACTOR'S DECLARATION
hLleby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
I of Division 3 of the Busiriess and Professions Code,.and°my license is in full force and
SIGNA: URE DAT
kOWNER•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
r permit to construct, alter, improve, demolish, or repair any structure,; prior to its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
the previsions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
71- Divisiog 3 of the Business and Professions Code, or that, he is exempt therefrom, and the basis
for thm alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjecs the applicant to a civil penalty of not more than rive hundred dollars ($500).
O 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. (Sec. 7044, Buisness and
r Proreszions 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,
• provide -d 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 proV.ng that he did not build or improve for the purpose of sale.)
❑ 1, aG 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 rot 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.)
❑ 1 an exempt under Sec. B. & P.C. for this reason
Date Owner
i
• WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate ofconsent to self -insure, or a certificate of
Worker's Compensation Insurance, ora certified `copy thereof. (Sec. 3800, Labor Code.)
Policy No. �Company r �"
CL:,opy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
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 .f California.
Date Owner
NOTIC= TO APPLICANT., If, after making this Certificate or Exemption you should become
subjeci 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 fcr which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
ThiE is a building permit when properly filled out, signed and validated, and is subject to
expiraton if work thereunder is suspended for 180 days.
I car t-fy 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, Sate, Zip
BUILDING: TYPE CONST
A.P. Number
Legal Description_
Project Description
No. 12503
OCC: GRP. -
Sourer Connect
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
E
[Estimated Valuation $2,000.00
PERMIT -. AMOUNT
s
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing .00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
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:
9
j
.d�'
b
s
t
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
h
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMSSEWER�L//
_j'qOUGH WIRING.
MOBILEHOME SVC.
BAR SINK
FOR. SQ. Ff. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT.
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SQ. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FRAMING
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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
SO. Ff. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1Va c
SEWAGE DISPOSAL
INSULATION/SOUND
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
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
FORMSSEWER�L//
_j'qOUGH 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
REMARKS:
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