003133 (BLCK)CrV aZlaGl.... IGu:,..
P.O. BOX 1504 No.00313
.
Building 78-105 CALLE ESTADO
Address AQ -940. 'W4LA QUINTA, CALIFORNIA 92253
Jobn Water
BUILDING: TYPE CONST.' - OCC'GRP.-,
' Mailing
Address �e
A.P. Number
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City
Zip
Tel.
Oe 1f:a._ .
Legal,.Description
Contractor.
Project Description
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Address .
83-876 Avenue Asa
'City
Zip
Tel.: .
Zndic
922011
347-6144
State Lic.
City
& Classif.-
•Lic. # i {
Sq. Ft.-
No. No. Dw.
Size
Stories Units
Arch., Engr.,
Designer
New ❑ ' Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
. _ . _... _ ....
Lic. #
LICENSED CONTRACTOR'S DECLARATION ,
hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of,the"Business and Professions Code; and my license is in full force and
-
�effect... . � r /' . .
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SIGNATURE" r 1.i •c:, .'•. c- •. DATE
.....
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OWNER -BUILDER DECLARATION
EStlmated V21UatI0l1
hereby affirm that I am exempt from the Contractor's.License Law for the following
gl� ,ii�SpCi
$4.125'66:
- reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a.J
• .
permit, to construct, alter, improve, demoiish, 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 provisions of the Contractor's License Law, Chapter 9 (commencing 'with Section 7000) of
" -Divisiori 3 of the-Busiriess and Professlons 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
Pian Chk.• De p -
' ��'3 ri
.
' subjects the applicant to a civil penalty of not more than five hundred dollars.(8500)'
Plan• Chk. Bal.
p,1, 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, euisness and y
Const.
S0.
Professions Code: The Contractor's License Law does not, apply to an -owner of property. who -
-
7
.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 -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 1, 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.•
' - x'50
such projects with a contractor(s) licensed pursuant to the -Contractor's License Law;) -
Grading
. 0 I am exempt under Sec..B. �_ ._ B. & P.C. •for this reason
Driveway Enc.
Date Owner.
Infrastructure
WORKERS COMPENSATION DECLARATION
hereby afhrmrthat'I have a certrflcate of consent to'self-insure; of a certificate of
'+�j��Worker
s Compensaiioir•Insuran`e or a�certified.copy thereof. (Sec. 3800, Labor Code.)
1�
tri: 3 :? ,� � +- j. t;AA-4A_07
S' PolicyNo.:,r`'i'r✓i,/ 1..•'Compa yam~ .. -
.'+v.' xrl�Y{3 L i :Yiflf:. -,.
LS,S
Co I
py:'s filed -with the city. • . ❑ Certified copy is hereby furnished..
TOTAL
R7
CERTIFICATE OF EXEMPTION FROM
REMARKS
-
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for.one hundred dollars •(8100) valuation
1
or less.) _ .... .. -.. _
.
certify that in the performance of the work for which this permit is issued, I shall not
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employ -any person1n•any manner so as -to become subject to the Workers' Compensation "
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate o7 Exemption' -you should become
ZONE:
BY:
s
''subject to' the 'Workers' Compensation provisionof the Labor. Code,' you- must' forth With
comply with such provisions or this permit shall be deemed "revoked.: -
MinimurriSetbackDistances:
,.
Front. Setback :from Center. Line
Rear Setback from,RearP.rop. Line
CONSTRUCTION LENDING AGENCY-
Side Street Setback.from Center Line
- I hereby affirm that there is a construction. lending agency for fhe 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, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have
y
6!4/37
read this application'and state that the above information is correct.
'
ISSued.by:
Date Permit
r.agree'to comply with all city and county ordinances and state laws relating to building"
construction, and hereby authorize representatives. sof this city to enter the above-.
mentioned property for inspection purposes.
Validated by;
Signature of applicant Date
Mailing Address
.Validation:
..
City, State, zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ, FT, ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ. 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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRYTRAY
AIR HANDLING UNIT CFM
GAS (ROUGH)
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
WATER HEATER
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
_ N ZEAM 611g,
SO.FT.GAR ® 3/ac
HOUSE SEWER
j
I 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
��rr �
FOUND. REINF.6— S —�
YY//
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
G UT
WATER HEATER
SERVICE
FINAL INSP.
_ N ZEAM 611g,
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
'
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL