07415 (SFD)Building
Address
Owner
Y 4.J .�j�f ,
P.O. BOX 1504 N o . V' # 0 411
78-105 CALLE ESTADO
55572 RMS LA QUINTA, CALIFORNIA 92253
Mailing
Address
City � F Zip: Tel:
fW. lei___ nn*f,en tr&na +;
Contractor `
National HortSill4e & tad
Address
Vii�4cG � Fe .
City Zip
State Lic. "; .. City
& Classif. Lic. # ,}
Arch., Engr.,
Designer
Address 2 Tel.
City Zip ' State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am Iicerised;under proVisions of 6apte,9 (commencing with Section
7000) of Division 3`of the Business and Pro,�fessions Code, and my license is in full force and •.
effect. 1 .�° a 16
SIGNATURE / c1 y DATE
OWNER -BUILDER DECLARATION r
I hereby affirm that`I am exempt fiom 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 or 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 ($500).
❑ I, as owner of the property, or my; employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code:The Contractor's License. Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building ,
or Improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ I, asowner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby 'affirm that -I have -a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. .Company
❑ Copy is filed with the city. . ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars_($,1p0) valuation
or less.) -�. "'�..
1 certify that in the performanceh of thg work for which this'p rmit is issued; I shall not
employ any person in any manner so as to become !Ajbjdct 'f6AhefW-0_rk`er91 Compensation
Laws'of California. i
Date .4 r -own?
er
NOTICE TO ,APPL'ICANT:-If-aRer-'m-aking-. this'%Certificate' of Exemption you should become
subject to the Workers' Compensation provisions of. the Laborl Code, you must forthwith
comply with such provisions or this permit shall be -deemed revoked. '
t
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
BUILDING: TYPE CONST.' OCC: GRP.
A.P. Number PrA want Phase IN �>
Legal Description
Project Description Tract 955M=l Plan I"
Sq. Ft. No. No. Dw.
Size im Stories Units
New ❑ Add ❑ Alter:❑.. Repair ❑
Demolition,❑, ,'_
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical z
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
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
FINAL DATE
- -INSPECTOR
3J 23` 90Permit
Issued b .
y,
Date
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
A.C. UNIT
2ND FL. SQ. FT.
LAB GRADE-
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
AI
DRAINAGE PIPING
WALL SQ. FT.
DUCT WORK
DRINKING FOUNTAIN.
SQ FT ®
(ROUGgr�2
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
REINF. STEEL
FLOOR DRAIN
MECHANICAL FEES
TEMP. POLE
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
WATER SYSTEM
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
SQ. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
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
0060UND PLUM
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE-
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
JffiSEWER OR
AI
ROUGH WIRING,
DUCT WORK
ROCK STORAGE
FOUND. REINFY l� (�S
(ROUGgr�2
b `
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.
��JJ
FINAL INSP �— [[[
FRAMING
FINAL INSP.
ING �-�
n. "✓
_) ^�
/�lL(� / / / u�
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
IATHING� _
MESH
INSULATIONISOUND&P/f I
���llV//
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL