07480 (RPL)Address x4-087 Swthm 'Hills
Owner
PeU Ell -is
Mailing
Address
� , n>hsa a
City Zip Tel.
City
CathedOnT: cit
State Lic.
& Classif. 574121
Arch., Engr:,`
Designer
Address
City
j LICE
I hereby affirm that I amtic
7000) of Divisid�n 3fof the BG:
effect. Af• A-
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
'Tel.'_.. .. .
92234 324-2232
- City
Lic. # 1oU
Tel
Zip (State
Lic. #
'CONTRACTOR'S DECLARATION
under Provisions•of Chapter 9 (commencing with Section
and Professions Code, and my license is in full force and
No. 07480
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number PGA Wst
Legal Description
Project Description ymi 1. 1502
Sq. -Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
SIGNATURE - �A DATE
REMARKS
'
OWNER•BUILDER DECLARATION
I hereby affirm that I -am exempt from the Contractor's License Law for the following
Estimated Valuation
� QAA
$27,800
800
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 rile a signed statement that he is licensed pursuant to
D
PERMIT
AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. '.
-
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
plan Chk. De 17
Plan Chk. Bal.
C
176.481
Const.'.
a 50
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
Mech.
3Q- 00
LI �i�i
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
MINI
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
❑ I, 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.
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
O I am exempt under Sec. B. 8 P.C. for this reason
Grading
Driveway Enc.
work for which this permit is issued. (Sec. 3097, Civil Code.)
Date owner
Infrastructure
Lender's Name
WORKERS' COMPENSATION DECLARATION
FINAL DATE
INSPECTOR
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.)
sf
Policy No. Company
Issued by:
Date 2 ermit
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
`•
�o , 1
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
'
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
-
�j } ,��ejr .}°i ¢•, g }^" � Y�"'».�'g 10•A, 10
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
ZONE:
BY: "
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
Setback
Distances:
comply with such provisions or this permit shall be deemed revoked. -
Minimum
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 Name
Lender's Address
FINAL DATE
INSPECTOR
This is a building permit when properly filled out, sighed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
sf
I certify that I have read this application and state that the above information is correct.
Issued by:
Date 2 ermit
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.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
A.C. UNIT
2ND FL. SQ. FT.
SLAB GRADE
YARD SPKLR SYSTEM
BONDING
MOBILEHOME SVC.
BAR SINK
POR, SO. FT. ®
STORAGE TANK
FORMS
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
GAS (ROUGH)
DRINKING FOUNTAIN.
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
REINF. STEEL
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
FINAL INSP.
GARBAGE'DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
WATER SYSTEM
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FIRE ZONE ROOFING
SQ.FT.GAR ® V4c
HOUSE SEWER
FIREPLACE
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE rPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR-
SETBACK0_66OUND
PLUMBR�/,�fd
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTC TANK
ROUGH WIRING.
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
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.
FRAMING
FINAL INSP.
ROOFING
�I� LTA ti tT
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESHv�—C-
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL