05763 (RPL)P.O. BOX 1504N Q 0-5763
7&105 CALLE ESTADO
Addrress 49-03 ^ AtJ ' i LA QUINTA, CALIFORNIA 92253
'Owner ,
RIMA WN
BUILDING: TYPE CONST. OCC: GRP.
Mailing ' "r4
Address SAM
City Zip
LA ' sir • 92253
.Contractor
..... H 74418 VEL2E WAY
City Zip
PATAT ,DASM 92263 34+
State Lica
& Classif. C53-52
Arch., Engr.,.,-
Designer
Address
A.P. Number. -
.g326 J Legal Description
Project Description-
No.
escription G3i�` E S�MIG $ SPA
L
LIC. # Sq. Ft.
Size
New ❑
Tel.
N o.
• Stories
No. Dw.
Units r
Add ❑ Alter ❑ Repair ❑ 'Demolition ❑
City
Zip
State
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with Such provisions of this permit shall be deemed revoked.
Minimum Setback Distances:
Lic. #
Front Setback from Center Line
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.rs + ` �r tr
Rear Setback from Rear Prop. Line
,tel SIGNATURE- -''✓ 'if, V - DATE
OWNER -BUILDER DECLARATION
1 hereby affirlm that 1 am exempt from the Contractor's License Law for the following,
reason: (Sec. 7031.5,Busuness 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 tree a signed statement that he rS licensed pursuant to
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
' subjects the applicant to a civil penalty of not more than rive hundred dollars IS 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
Professions Code: The Contractor's License Law does not apply to an owner of property who
Ihereby affirm that there is a construction lending agency for the performance of the
Estimated Valuation f
3 s •
PERMIT
Plan Chk. Dep.
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
EleCtrlCal' -
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or inprove for the purpose of sale.) -
Plumbing
O I, as owner of the property, am exclusively, contracting with licensed contractors to con-
strut[ 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
succi projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec B. & P.C. for this reason
S.M.1.
Grading
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION - '
- Date Permit .- .
I agree to comply with all city and county ordinances and state laws relating to.building
I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a,certitied,copy thereof. (Sec. 3800, Labor Code.) '
Policy No Company f•Ly!"
construction, and'hereby authorize representatives, -of .this city to enter the above-.
O Copy isliled with the city- O Certified copy is hereby furnished.
TOTAL
by:
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S 100) valuation
or less.)
I 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
• i5 -
AMOUNT
87.75
135.00
24.00
30.• L'I0
. X34 .
nCMHI'SRJ � i�+w. _ ter.
x-t,ffl.gi 5 ls> 1� f' `.I ii5V'4 . w 7 IV
Date Owner
NOTICE TO APPLICANT: 8, 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 of 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
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) ',
- Side Setback from Property Line '
Lenders Name
Lenders 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..
�14 �/�
3
1 Car ity that I have read this application -and state that the above information is correct.
Issued by:
- Date Permit .- .
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.,Validated
by:
Signature of applicant_ Date'
Mailing Address
Validation: -
--
City,. State,, Zip IIs
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB. j/ f� DING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS
SEWER OR SEPTIC((( TANK ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
FOR. Sp. FT. ®
GAS (ROUGH) METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
GAS (FINAL) TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
WALL Sp. FT.
DRINKING FOUNTAIN.
GRADING
cu. yd.
$ plus x$
=$
URINAL
Sp. FT.
FRAMING
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
REMARKS:
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUITO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
SPARK ARRESTOR
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
INSULATIONISOUND
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
HOUSE SEWER
CERT. OCC.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE 7NST.
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. j/ f� DING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC((( TANK ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL S u�
,
GAS (FINAL) TEMP. POLE
GROUT
710
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
w C
REMARKS:
VENTILATION17
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION l74
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL