11305 (BLCK)T44t-1. '4
P.O. BOX 1504
Building 78990 DRY CREEK LA QUINTA, CALIFORNIA 9
Address
Owner
PETER HISIS REL -LI
Mailing
Address
City Zip Tel.
INDIAN ABLLS 92252
Contractor -
f'DESERT SAND CONST
A Address
City Zip Tel.'
BERMUDA DUNBS 92201 345-5490
State Lic. City
& Classif. C29 488837 Lic. # 586
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby.affirm that I aTAIcensed under provisions of Chapter 9 (commencing with Section
000) of')ivislon'3 of the Business,and Prote��ssions CbBe,and:my license is in full force and
ffect. ! !fes r �' i ✓/ f. /_ � G' , e_.. --t
6 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
Y; permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
-requires requires the -applicant -for such permit to We a signed statement that he is licensed pursuant to
the provisions of 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 violaliDn of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than two hundred dollars ($500).
i O I, as owner of the property, or my employees with wages as theirsole compensalion, '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 himseff 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-bullder will have. the burden
of proving that he did not build or improve for the purpose of sale.)
❑ 1, 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 bunds or brtproves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
❑ I' mw 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
m
Worker's Copensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. -Co mpany
b Copy is filed with the city. ❑Certified dopy 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, I shall not
employ any-Ferson in any manner so as to become subject to the Workers' Compensation
Laws of Caliornia.
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.
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, CMCode.) _ '
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
No.
i
11305
BUILDING: TYPE CONST -f OCC: GRP.-
A.P. Number
Legal. Description
Project Description 190' X,6' BLOCK WALL
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
Estimated Valuation $4750
PERMIT �` ` AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const. 70.00
Mech.
Electrical )
Plumbing
S.M.I. .50
Grading
Driveway Enc.
Infrastructure
r
TOTAL $72.50
REMARKS Sf`}y. 3C1 r ylc''S''it?T40 {ti�—Yte�;
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
1ST FL. SO. FT. ® $
UNITS
YARD SPKLR SYSTEM
2ND FL. SO. FT.
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
CAR P. I SO. FT.
WALL SO. FT.
DRINKING FOUNTAIN.
SO FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
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
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,TEM/PERM
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 ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Yac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
JDBL
SMI FEE PLUMB. FEE
STRUCTURE
SETBACK
SLAB GRADE
FORMS
MOUNDffS n
. REINF. 57-0 /
REINF. STEEL 1/L
GROUT
BOND BEAM
LUMBER GR.
FRAMING
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
-I-
NAL INSPECTION- 5
CERT. OCC.
FENCE FINAL
GARDEN WALL FINAL
PLUMBING
GROUND PLUMBING
ROUGH PLUMB.
SEWER OR SEPTIC TANK
GAS (ROUGH)
GAS (FINAL)
WATER HEATER
WATER SYSTEM
FINAL INSP.
ELECTRICAL
UNDERGROUND
BONDING
ROUGH WIRING.
METER LOOP
TEMP. POLE
SERVICE
HEATING & AIR COND.
A.C. UNIT
HEATING (ROUGH)
DUCT WORK
HEATING (FINAL)
FINAL INSP.
GRADING
FINAL INSP. cu. yd.
$ plus x$
SOLAR
COLL. AREA
STORAGETANK
ROCK STORAGE
OTHER APP./EOUIP.