06838 (SFD)Buildin
Addr
ess 44-030 Sweetbush Lana
Owner
Mailing
Address 41-875. H•shianton St.
City I Zip Tel.
m ueserc
Tel.:
4
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
State Lic. I City
& Classif. 493919 Lic. # 1231
Arch.,'Engr., -
Designer
Address Tel.
City .. IZIp ILicte
LICENSED CONTRACrOWS DECLARATION
I hereby affirm that I am licermsed under provisions of Chapter9 (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 Contractors License Lary for the following
reason: (Sec. 7031.5.Busness and PYofessiors Code= Any city or county wfuirh requires a
permit to construct, atter, irprove, P I or repair any structure, prior to Its, ssuance also
requires the applicant for such permit to ria a signed statement that hes licensed.pursuant to
the provisions of the • ConhxtorlsLicense rme Law, Chapter 9 (eaencig with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therehom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by ay applicant for a permit
subjects the applicant to a civil penalty of not nae than five hundred doI g(S500)-
0
(5500)_❑ I, as owner of the properly, 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, Buuisness and
Professions Code: The Contraders License Law does not appy to an owner of property who
builds or Improves thereon and who does such work himself or through his own employees,
provided that: such bmnivemerds are not kdooded or offered for sale. Il, however,• the buddlhg
or improvement is sold within one year of caz*rlsban, the ownerfinider will have the burden
of proving that he did not buil 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 Conbadoes License Law
does not apply to an owner of property who braids or "reproves thereon, and who contracts for
such projects with a contractar(s) licensed pursuant to the Contractor's License Law.) '
❑ 1 am exempt under Sec a g P.O_ for this reason
r j '�
Date ..7 �. �. L.owner ...�* ..tr...�1...... % c f✓,
WORKERS COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, ora certified copy thereof_ (Sec. 3800, Labor Code.)
Policy No. Company
O Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF OMEPTION FROM
WORIGIISS COMPENSATION INSURANCE
(This section need not be co plrled i the peril for one hummed dollars (Sloo) vahuation
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 '_ Owner
NOTICE TO APPLICANT: t, after maMig this Cerbticate of Eceeptim you should become
subject to the Wodres' Corpehsahan provisions of the Labor Codeyou must forthwith
comply with such provisions or this peed shall be deemed revoked. . .
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for performance perfownce of the
work for which this permit is issued (Sec. 3097, Cirri Code.) -
Lenders Name
Lenders Address
This is a bihilding permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 100 days.
1 certify that 1 have read this application and state that the above information is correct
I agree to comply with all dty and tbuMy arefuma,noes and state laws relating to -building
construction, and hereby autfmor�e represermtatires pf this city to enter the above..
mentioned property for inspection purposes
Signature of applicant Date'
Mailing Address
City,. State, Zip
No. 08838
LDING: TYPE CONST. OCC: GRP. -
Number %. act 22982 Phase IV
al Description Cactus Flower
ect Description Plan UAR ` Lai sty
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
I.
IFINAL DATE INSPECTOR
Issued by: Date Permit.
Validated by:
Validation:
Sq. Ft. 2134
Size
No. No. Dw.
Stories Units
New ❑ • Add ❑
Alter ❑ Repair ❑ Demolition q
Estimated Valuation
313,$3
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
. bu
Electrical
XIS. i1
Plumbing
I 37K.5U
S.M.I.
Grading
Driveway Enc.
Infrastructure
2 0 w a, i
TOTAL
REMARKS
,s�44.a"#r?�6 ,3,'�.Tr.hi•.,r^r��rhnn -, Sn
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
I.
IFINAL DATE INSPECTOR
Issued by: Date Permit.
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
r
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL SQ. FT.
DUCT WORK
ROCK STORAGE
FOUND. REINF. %, (6 va
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
REINF. STEEL
GAS (FINAL) TEMP. POLE
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRAINAGE PIPING
CAR P. SQ. FT. ®
LUMBER GR.
FINAL INSP. 8 �Q /Q
�/
FRAMING G 13 ��0/i
FINAL INSP. Riio:':�
DRINKING FOUNTAIN.
WALL SQ. FT.
REMARKS:
URINAL
SQ. FT.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
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
LAUNDRY TRAY
AIR HANDLING UNIT CFM
MESH
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
CERT. OCC.
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/. c
SEWAGE DISPOSAL
INSPECTOR'S SIGNATURESIINITIALS
SQ.FT.GAR ® 3/ac
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
NO PLUM BIN Iy 9 UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE �(� l�/a (�ROUGH
PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC S ROUGH WIRING,
DUCT WORK
ROCK STORAGE
FOUND. REINF. %, (6 va
GAS (ROUGH) O G 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. 8 �Q /Q
�/
FRAMING G 13 ��0/i
FINAL INSP. Riio:':�
ROOFING 1 Q< K
1 IQ
G�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
]�
GAR. FIREWAL ,- — ?o -/—
LATHING
MESH
INSULATION/SOUND( 0
FINISH GRADING
FINAL INSPECTIONC/;
/
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
4