11658 (RPL)4 . •
P.O. BOX 1504 N o . 11658
Building 78-105 CALLE ESTADO
Address 55-215 aouthern Hills LA QUINTA, CALIFORNIA 92253
Mailing
Address 42--600 Cook St. #200
City Zip . Tel.
Palm Desert, Ck 92260 568--2828'
Contractor
Address . I
74045 Mckinabird Tr.
BUILDING: TYPE CONST. - OCC: GRP. -
.P. Number
Legal Description
Project Description Chancre out' r)ool heater I9BB
Indian Wells,
ICA 92,210
341-1.127
State Lic.
City
& Classif. 7609$0
Lic. # 351Sq.
Ft.
No. No. Dw.
Size
Stories - Units
Arch:; Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ 'Demolition ❑ .
Address
Tel.
City
Zip
State
Lic. #
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. -
SIGNATURE DATE
"
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law -for the following
Estimated Valuation
$1,300.00
reason: (Sec. 7031.5,8usfness. and. Professions Code: Any .city or county which requires a.
'
permit to construct, after, Improve, demolish, or repair any structure, prior to dts.issuance also
requires the applicant for such permit to file a signed statement that'he Is licensed pursuant to
PERMIT
AMOUNT
the provisions of the Contractor's License Law, Chapter.9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he Is exempt-therefrom,'and the basis.
for the Any Section 7031.5 •by 'any for.
PI9n Chk. Dep:
alleged exemption.. violation of applicant. a permit
subjects the applicant to a civil penalty of not morethan rive hundred dollars.($ 500). -
-
Plan Chk.. Bal.
-
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
(`,Oust.
3 • Vu
Professions 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, .Mach:
provided 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
- Electricals
'
of proving that,he did not build or Improve for the purpose.of sale.)
01, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
Strutt the project. (Sec. 7044, Business. and Professions Code:, The Contractor's- License Law
does not apply to an owner of property who builds or.lmproves thereon, 'and who contracts for
S.M.I.
-
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION • •^
a ^:
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
❑ Copy Is flied with the city. O Certified copy is hereby furnished.
I. TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(Thissection need not be completed If 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 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. -
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
REMARKS
�...'r-3 �n.e t ,ri •v J r�iS. � +'f., a i....!?ri ; ft .
1"•Yt" _ " i:(•!:i?:i;`�`i;,i'"f (•�i� .i: _ _, ,�i, ,C!4Y
ZONE: BY:-
Minimum
Y: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:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. Ff. ®
MOBILENgmE SVC.
BAR SINK
GAR. SO, FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPIEOUIP.
DRINKING FOUNTAIN.
SO FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN 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 ® 1% c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/4c
HOUSE SEWER
LATHING
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
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPIEOUIP.
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
fftFINAL INSP. N
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURBSIINITIALS
GARDEN WALL FINAL