10925 (PAT)Tity)-4
P.O. BOX 1504 No. 10725
Building 79-025 La Palma Dr. 78-105CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
`.L°t1 i f lSY
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address 78-825 La Palma A.P. Number
CityTel.
C
La uinta T
ip 92253 Legal Description
Contractor
Jeff Peterson Project Description
Address __ Ratio Cover
1209 E. Oth
City Zip . Tel.:
Beaumont 92223 $45-1193
State Lic.- - City
& Classif.�Lic. # �� Sq. Ft. No. No. Dw.
f -'1 Size Stories - Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lica#
.LICENSED'CONTRACTOR'S DECLARATION
1 hereby affirm-that�am licensed under
.provisiaPs of Chapter 9 (commencing with Section
700094t. 7006t. ivision 3 of,thee BBAssi ss and -Profess i* Code, and my license is in full force and
SIGNATURE L _a tf'" DATE
✓r rt' (� OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following 6,288 '
reason: (Sec, 703).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 PERMIT AMOUNT
the provision o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) o/
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 Plan Chk. Dep. - o
subjects the applicant to a civil penalty o/ not more than rive hundred dollars.(E500). Plan Chk. BBI. 5 $ 5
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 Const. 90.00
Professions Code: The Contractor's License Law does not apply *to an owner o/ 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:lor sale. If, however, the building
or improvement is sold within one year of completion, the owner -budder will have the burden Electrical
of proving that he did not build or improve for the purpose of sale.)
❑ 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 n
does not apply to an owner of property -who builds or improves thereon, and who contracts /or S.M.I. .70.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
O I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date owner Infrastructure
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.
r TOTAL ''.i 9'0VZU
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This sssection need not be completed, if the permit is for ion � died dollars ($100) valuatlonor i t
I certify that in the performance of,th@ work�for whicfjrthis p€rmit is issued, I shall not - °
employ any person in any manner so as tosbeco subject tb rte Workers' mpensation._
Laws of California: C
Date Owner '
.,t NOTICE TO APPLICANT: II,jCtiRer�graking is (Certfficate of Exemption you should become
. ' subject' to the Workers' Compensahon Jovisions"of the Labor Code, you must forthwith
comply with such provisions or this.permd shad be deemed revoked. -
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 it 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
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:
s''
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. 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
ROUGH PLUMB.
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
GAS (ROUGH)
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
SO. FT. ® c
BATH TUB
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ic
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
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$
c$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
f _ _ �
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