15272 (RC)��.
4.4
P.O. BOX 1504 No. 15272
Building 78495 CALLE TAMPICO
Address 550-855 Washington Suite 28 LA OUINTA, CALIFORNIA 92253
O,wrier r
a"evall BUILDING: TYPE CONST: OCC:
Mailing GRP.
Address 73..430, Highway Ill A.P. Number
City Zip Tel.
..Palm Desert 9226£ 346--3679 Legal Description
Contractor kyhifii/bud ldei� tian nt
owner/builder Project Description
Address impg'�'ive�fent.
.
City Zip Tel.'
State Lic. City
& Classif.. Lic. # 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
I hereby affirm that 1 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:
SIGNATURE DATE -
OWNER -BUILDER DECLARATION Estimated Valuation -0
^
I hereby affirm that I am exempt from the Contractor's License Law for the following ri V r.
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, atter, 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 provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000)_ Of
Division 3 o/ the Business and Professions Code, or that. he is exempt therefrom, and the basis
/or the alleged exemption. Any violation of Section 7031.5 by 'any applicant /or a permit Plan Chk. Dep.
subjects the applicant to a civil penalty o/not more than Five hundred dollars ($500). -
I, as owner of the Pro
Plan Chk. 681.-
0 '. work, and the strueCtu a is not mended or�offeredefor sale. 7044 e8ur-sness and
Professions Code: The Contractor's License Law does not apply to an owner o/ property who CDn$t. 45.00
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 said 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 contractors) Qcensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec B. 8 P.C. for this reason ' Grading
Driveway Enc.
Date h " 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
❑ Copyis filed with the city_ ❑ Certified copy is hereby furnished. -
�TOTAL4s_ -so
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE . ,.
REMARKS
(This section need 'not be completed B the permit is for one hundred dollars ($100) valuation
i
or less.)
,
I certify that in the performance of the work for which this permit is issued, I shall -not
'
employ any parson In any manner so as to become subject to the Workers'' Compensation
Laws of California
Date -Own er
NOTICE TO APPLICANT: N, 'ager making this Certificate of Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. -
Minimum Setback Distances:'
Front Setback from 'Center Line
Rear Setback from Rear,Prop. Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND,
Side Street Setback from Center Line
SHALL SUBJECT AN EMPLOYER TO CRIMINAL' PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE.COST OF COMPENSATION,
Side Setback from. Property Line
DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR. CODE, • INTEREST, AND
ATTORNEY'S FEES.
' This is a building permit when property filled out, signed and validated, and is subject to
FINAL DATE
INSPECTOR
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.
Issued by:
Date +� -+==P�rrrlt '
1 agree to comply with all city and county ordinances and state laws relating to building
1 �.
construction, and hereby authorize representatives -of this city. to enter the above-.
3
mentioned property for inspection purposes.
Validated by:
Signature of appllcant Date
I
'LJ
Mailing.Address -
Validation:
City, State, Zip
I I J U L .t1 1) lZJ ,3 .1
f3y....._._._.- ---- -
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
�" lG ����
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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,s$
ROOFING
�" lG ����
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
_.
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCG
FENCE FINAL
INSPECTOR'S SIC;NATURESJINITIALS
GARDEN WALL FINAL 71