11712 (CP)P.O:'BOX 1504 No. 11712
78.105 CALLE ESTADO =
Address 55 600 Southern Hills LA QUINTA, CALIFORNIA 92253
Owner , p
�
Sun.r1se Crim all
BUILDING: TYPE CONST:
OCC: GRP..
Mailing -
Address 42 -600 -Cook St. #200
A.P. Number
City
Zip
Tel.
Pala Desert,..-
92260
568•-2828
Legal Description
Description'
Change .pool heater Pvol Ifni, ;
°
ContractorProject
rrr1'dert . P6ola
Address
74045 Mockingbird Trail
..City
Indian _6�ells,. CA
Zip -
92219
Tel.:
341-•3127
t
State Lic.
&Classif. -2609`50 "'
City
Lic.# 351
Sq. Ft.
Size- ..
+'
No. No.Dw.
Stories . .. Units •..:
-Arch:, Engr., - -
Designer
New ❑ Add ❑F.;
Alter ❑ Repair ❑ Demolitioh;❑
Address
Tel.
1 .
City
State
JZip
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 thef',Business and Professions Code, and my Ilcense is in full force and `
effect: 7
J
'
SIGNATURE DATE
"' : 'OWNER•BUICDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the, following
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 applicant for such permit to file a signed statement that he Is 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 five hundred dollars ($500). ..
❑ 1, as owner of the property, or my employees with wages as their,sole compensation, willPlan
' do the work, and the structure Is not Intended or offered for sale. (Sec. 7044,.Bulsness and
- 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,Mech.
provided that such Improvements are not Intended or offered for sale. •U, however, the building
or Improvement Is sold withinoneyear of completion, the,owner:builder will have the burden
of proving thaf,he did not build or Improve for the purpose of sale.)
Estimated Valuation
$I f 300:0 ;
I PERMIT
- ` - -
AMOUNT
•..Plan Chk. Dep..
Chk, Bala
COrist.
'
-
- - ;1'U •flit
Electrical'
Plumbing.
-.;.
❑ 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.-.
• such projects with a contractor(s) licensed pursuant to*the Contractor's License Law.)
❑ I am exempt under Sec. - +B. t> P.C. for this reason -
1
S.M.I. • -
_ •�..
Grading
Driveway Enc.
.
.. Date � � Owner �.r:`. >,i
Infrastructure
- -
WORKERS' COMPENSATION DECLARATION. .
' I hereby affirm that.l have a certificate of consent to self -insure; ora certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. •. .Company
❑ Copy Is filed with the city. ❑ Certified copy Is hereby furnished.
TOTAL
• �'�
CERTIFICATE OF EXEMPTION FROMo
WORKERS' COMPENSATION INSURANCE
oThis section need not be.,completed If the permit Is for one hundred dollars $100 valuation
r less.) ( 1'
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 theWorkers' Compensation
Laws of California.
REMARKS
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f'(> tx 3. = 3 r n •i% j, it
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a
" Date:—Owner
NOTICE TO APPLICANT: IF, afar 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
• 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 Street Setback from Center.Line
Side Setback from Property Line
Lender's Name
FINAL DATE
-
,
INSPECTOR
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 sof this city to enter the above-.
mentioned property for Inspection purposes. •
-Issued by:
Validated by:
-Date Permit
"
Signature of applicant— Date
Mailing Address.Validation..
-
,
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SQ 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
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
i
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1Vi c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® VAc
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
I 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 APPJEOUIP.
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
/1 //(
INAL INSP. Z. / �yP(
c )
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUFESJINITIALS
GARDEN WALL FINAL