10603 (BLCK)Building
Address 79.189 .Jack Rao
Owner
X & V ConstracUon
Mailing
Address 42-151 Sandy
City.. Z'p g2.al
Contractor
Desert Sand Constr
Addres12151 Bandy Bay Rd
City Zip
State Lic.
& Classif. 488937
P.O. BOX 1504
78-105 CALLE ESTADO
TRai.3 LA OUINTA, CALIFORNIA 92253
s
Tel. 345'5490
Tel.:
345-54100
Lic. # 636
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I.am licensed under provisions -of Chapter 9'(cc
17000),(of Division 3 of th"e_BuAlness and Proless!QnvOode, and mv_lH
h Section .
force and
No. 10603
BUILDING: TYPE CONST. - OCC: -GRP.
A.P. Number
Legal Description
Project Description 224' or 6' block wall
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
.1.
OWNER -BUILDER 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
Estimated Valuation
PERMIT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Cade, or that. he is exempt therefrom, .and the basis
Plan Chk. Dep.
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).
Side Street Setback from Center Line
0, 1, as owner of the property, or my employees with wages as their sole compensation, will.
Plan Chk. Bal.
do the work, and the structure is.not Intended or offered for sale. (Sec. 7044, Buisness and
Const.
Code: The Contractor's License Law does not apply to an owner of property who
Issued by:
builds or Improves thereon and who does such work himself or through his own employees,
Mech. -
provided that' such Improvements arenotintended or offered. for sale. If, .however, the building
or -Improvement is sold within one year of completion, the owner -builder will have the burden
Electrical
of proving that he did not build or improve for the purpose of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing -
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 contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc
Date Owner
f
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
01Copy is filed with.the city. O.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 ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, l 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.
.i
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 f 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
Infrastructure
TOTAL
5,600
AMOUNT
�3.•dt�
BfYAL 1 r 81.66,
U-60
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
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. SO. FT.
WALL SO. FT. ®
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
Y Y /�
LAUNDRY TRAY.
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
OND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
`. SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 34c
HOUSE SEWER
FRAMING
FINAL INSP.
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
96aND. REINF• . -
Y Y /�
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
OND BEAM
�Z
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 SIGNATURESIINITIALS
GARDEN WALL FINAL