07451 (SFD)P.O. BOX 1504 No. 0751.
Building 78-105 CALLS
Address 54"" Shoal �k- LAeQUINTA, CALIFORNIAORNIA 92253
Owner
Suar9' se Cathy
Side Street Setback from Center Line
r Jr ;OWNER -BUILDER DECLARATION p`
I hereby affirm that I 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 applicant4or subh permit to file,a-signed statement. that.he is licensed pursuant to
FINAL DATE
PERMIT
the provisions of the,,Contractor's License taw, Chapter •9 '(comm&.'icing 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 703.1.5 ''by 'any applicant for a permit
BUILDING: TYPE CONST:
. . OCC: GRP.
Address
Address Cook St. fjjjit,�1,i, 200A.P.
Plan Chk. Bal.
Const.
PGA WEST - Phase 20A
.42-600
'Electrical '
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.)
Number
O I, as owner of the property, am exclusively contracting with licensed contractors to con.
City
Zip
Tel.
Grading
Driveway Enc.
PlanPalm
aeser
92,268
568.2828
Less Ci t.
Legal Description
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Contractor
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Polic No
Project Description
Trict 2D701-3
liational Land & lortraa
e
Address
City
Zip
Tela
State Lic.
& Classif. 288134
City
Lic. # 328
Sq. Ft. 11827
No. No. Dw.
Arch:, Engr.,
Size
Stories Units
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ -Demolition ❑
Address
Tel.
City I Zip
yr LICENSED'CONT
1 hereby affirm that I am licensed under
7000) of Division 3 of ahe Business and;Pi
effect.
I State
Lic. #
OR'S DECLARATION
ions of Chapter 9 (commencing with Section
bns Code, and my license is in full -force and
_teal e-- !1
blUNAtURE - - A DATE
Side Street Setback from Center Line
r Jr ;OWNER -BUILDER DECLARATION p`
I hereby affirm that I 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 applicant4or subh permit to file,a-signed statement. that.he is licensed pursuant to
FINAL DATE
PERMIT
the provisions of the,,Contractor's License taw, Chapter •9 '(comm&.'icing 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 703.1.5 ''by 'any applicant for a permit
Date 3/30/9germit
Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ 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
Code: The Contractor's License Law does not apply to an owner of property, who
Plan Chk. Bal.
Const.
Mech.
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
'Electrical '
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.)
Plumbing
O I, as owner of the property, am exclusively contracting with licensed contractors to con.
struct the project. (Sec. 7044, Business and Professions Code: The Contractcr'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 Contractor's License Law.;
❑ 1 am exempt under Sec. B. & P.C. for this reason
Grading
Driveway Enc.
,Date Owner
Infrastructure
Less Ci t.
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.)
Polic No
AMOUNT
563.06
688.50
51:.0
101.12
131.43
7.93
1,279.x'3
Y Company
O Copy is filed with the city. ❑ Certified copy is hereby.furnished. j
TOTAL 2,822.09 Z �``�:. 72 /71"
/
CERTIFICATE OF EXEMPTION FROM REMARKS .- a ren" wry �� t
WORKERS' COMPENSATION INSURANCE "
This section need not be completed if the '+4 � �°`" 1 b t IlW Y_1 1445441 V'' *
( p 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 of California.
Date---L-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
i comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances:
Font S tb k f C t L'
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 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
r e ac rom en er Ine—
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date 3/30/9germit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS/
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
AS (ROUGH)
METER LOOP
GAR. SO, FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT.
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN
SO FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
_ $
WATER PIPING
NOTE: Not to be used as property tax valuation
/
/ AL INSP. r/ �/ ',
v
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
FIRE ZONE ROOFING '
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
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
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
ROUND PLUMBINd
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(/; `j-'-
AS (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.
/
/ AL INSP. r/ �/ ',
v
FRAMING -7 v! „
i
FINAL INSP.
ROOFING v`
'7—
9;17 —i
REMARKS:
ila
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
112 INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL