001765 (RPL)Building
Tel.
Address
4449
Owner
Zip
State
Lic: # '
C,tr•
Mailing
Address
LICE_NSE_D 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,ProfessionseCode; and my license is in full force and
effect:
City
r
I. .
3ulu
Contractor
..
'OWNER-BUILDERDECLARATION'J - . - •: 1 , 'T
I hereby affirm that I am exempt from the Contractofs.License Law .for the following
.,,.reason:
reason: (Sec. '703 'A
031.5,Business and Professions Code:.ny.• city or county • which requires a '
p _
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 pursuan64o.
the provisions of. the Contractor's License Law,Chapter 9 (commencing with Section 7000); of
Division' 3 of the Business and Professions Code;. orthat. 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).' ,
$500).'-'''
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. '
- 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: ,Ir; 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.)'
O'l, as owner of the property, am exclusively contracting with licensed contractors to con-
struet. 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.) - -
• .O 1 am exempt under. Sec. B. & P.C.- for this reason
Estimated Valuation
�•�%�+
Validation:
Address
.
- -
- 'AMOUNT
_
P.O. BOX 1504
78-105 CALLE ESTADO
bet SMOC:�M Cr,, -.St Dr. LA QUINTA, CALIFORNIA 92253.
ip St. mite 27M .. ;
Zip Tel. ,
City ... Zip Tel...
Palm Dem 92200�
State Lic. City
& Classif:• : 442922 Lic. # 237
Arch., Engr., . .
.Designer
BUILDING-. TYPE CONST. OCC: -GRP: -
A.P. Number 613-42�1 003'
Legal Description TCect 1"03..
Project Description�-
Sq. Ft. 216 No. No. Dw.
New q. Add 'D Alter 0' Repair 0 Demolition 0
Address
Tel.
Minimum Setback Distances:
' City
Zip
State
Lic: # '
Side Street Setback from Center Line
Side:Setback from Property. Line
LICE_NSE_D 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,ProfessionseCode; and my license is in full force and
effect:
FINAL DATE
r
..... _. -. ... ... ...
.. .
,,. , ,..rte ,, ,
SIGNATURE 49 � DATE
..
'OWNER-BUILDERDECLARATION'J - . - •: 1 , 'T
I hereby affirm that I am exempt from the Contractofs.License Law .for the following
.,,.reason:
reason: (Sec. '703 'A
031.5,Business and Professions Code:.ny.• city or county • which requires a '
p _
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 pursuan64o.
the provisions of. the Contractor's License Law,Chapter 9 (commencing with Section 7000); of
Division' 3 of the Business and Professions Code;. orthat. 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).' ,
$500).'-'''
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. '
- 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: ,Ir; 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.)'
O'l, as owner of the property, am exclusively contracting with licensed contractors to con-
struet. 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.) - -
• .O 1 am exempt under. Sec. B. & P.C.- for this reason
Estimated Valuation
�•�%�+
Validation:
PERMIT ' '- '-
.
- -
- 'AMOUNT
_
- Plan Chk.. D.ep.... .. :. - "
-
- •�
Plan Chk. Bal.
p�
25.02
COr1St. ' "
3 50'
w
Mech.
,.
:Electrical
Plumbing
S•M,I,
Grading
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I herebyaffirm that 1'.have a'certificate of consent to self-insuie, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
.' Policy'No. - .Company ..
0 copy.is filed with the city. ❑.Certified, copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed % the permit is for one hundred dollars ($100) valuation
or less.) .. .. ..
I certify that in the performance of tha 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
-
TOTAL
64.02
REMARKS.
}
NOTICE TO APPLICANT: If, after making this Certificate of Exemption . you should become
subject to the Workers' 'Compensation provisions of the Latioi' Code, you.:must forthwith
comply with such provisions or this permit shall be deemed revoked: '
CONSTRUCTION LENDING AGENCY - 1 .
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 representathi s--of-this city to enter the abo'vea:
mentioned property for inspection purposes.*
Signature of applicant
`bate
Mailing
te
Mailing Address
_'- �'�""•"" �'''�'°'s"" (- yp.,..._/'
City, State, Zip r t
/r f
HARD C01
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'
Issued by:
Date`" Permit
Validated by.'
Validation:
A30"18
1G 30 _..64.62...CK ..
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. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
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.000L 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 ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
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 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
FINAL INSP.
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 SIGNATURES/INITIALS.
GARDEN WALL FINAL