04184 (SATT)48 4
P.O. BOX -1504
78-105 CALLE ESTADO
78-375-- Terra Cotta Ct. LAQUINTA, CALIFORNIA 92253
Bmievard Davvalbomnt
BUILDING: TYPE CONST: OCC. GRP.
777.8. Main St. t.suice i0s . A.P. Number.
Zip - Tel.
92686 714-$47-
'-8056 Legal Description
to
Project Description -Ruildincr 11, Plan 2
Ramer
Zip
& Class 462.81'
--ZZ-1:
-Arch.;Engr.,
'Designer `
Address
Tel.
City
Lic. #
Tel.
Sq. Ft., 912
Size
New 0 Add 0
No. No. Dw.
Stories Units `
Alter 0- Repair 0 Demolition,0
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm.that I am licensedunder 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.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
V
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct,. after, 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
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. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars (S 500).
0 1, as owner of the property, o I r my employees with wages as their sole compensation, will
Plan Chk. Bal.
Const.
331.00 -
'do the work, and the structure is not intended or offered for sale. (Sec. 7044, =ass and
Professions Code: The Contractor's License Law does not apply to an owner of property who
Mech.
.36.00
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
44.76
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
0 1, 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
S.M.I.
4,59
• such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) •
0 1 am exempt under Sec. B. & P.C. for this reason
Grading
Driveway Enc.
Date Owner
Infrastructure
1, C7.5y! ,
Frincte-Toad I Lzard,
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
0 Copy is filed with the city. 0 Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
v
if -
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thp 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.- If, after making this Certificate of 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.
ZONE: BY:
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.)
—Side
Setback from Property Line
Lender's Nam
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
FINAL DATE
INSPECTOR
6/28/UUii r
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 properly for inspection purposes.
Issued by:
Validated by:
Date —Permit
Signature of applicant -Date
Mailing Address
Validation:
ILE
GOLDENROD - ASSESSOR'S OFFICE, HARD COPY -FILE
%
City, State, Zip
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT rp $
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. a
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT. at
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. Ca
TEMP. POLE
GROUT
DRAINAGE PIPING
CARP. SO FT. g
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. Q
=E
LUMBER GR.
--77��l
FINAL INSP. �b v �^l
URINAL
SO. FT. to
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
-
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHERIAUTONDISHI
APPLIANCE DRYER
FIREPLACE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
I IKITCHEN 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 a 1 I c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/,c
HOUSE SEWER
CERT. OCC.
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 8 AIR COND. SOLAR
SETBACK
UND PLUMBING 1 7 i/_
!�
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
UND. REINF, r2 ��
v-
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
_plus -x$
=E
LUMBER GR.
--77��l
FINAL INSP. �b v �^l
RAMI �fL
(�
FINAL INSP.
ROOFING
lr
-
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
�7 �j
ING Z_ /
MESH
S ON /SOUND 'l_ --7_P L,4�32
FINISH GRADING
FINAL INSPECTION 9
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL