9657 (PLBG)A�
P.O. BOX 1504' a �~ N o . 9657
f
Building•78-105CALLE ESTADO
Address 53-65SS . V11lca . LA'QUINTA. CALIFORNIA 92253'
Owner ! . `' _ t...`•„
X312 tzii3• Xf'.Lehax. %Q' BUILDING: TYPE CONST. -0CC7GRP.
Mailing
Address P.' 0: Box 1742 L
A.P. Number
City Zip , Tel.
:a Qui'ntd • 92253 Legal Description
Contractor project Description
Da: tei'iYid Coritruci ion it6. SEWER HOOK UP.
'.Address . �. °: . • . _
.50-305 Hwy 111
•City.. Zip Tel.'
Coach ll� 922.35 396-5544
State Lia City _
& Classif. , C42 312954 Lic. # 31 Sq. Ft. 'NO*.No. Dw.
Size Stories Units'
Designer New -Add ❑ Alter El Repair ❑ Demolition'❑
Address Tel.
City .. Zip State ;*
Lic. # ,
y LICENSED CONTRACTOR'S DECLARATION,. rr
I hereby afflrm(ihat 1 a licensed unde'r provRions of tthapter 9 (commencing with Section ' l
700 ) of Di4(1'siroria3 �aof the Busin s d Prof ons Cade- and my licen is inol force Ind s
S1 ATURE "" DATE '
- ` . - ;.OWNER-B.UJLOER DECLARATION.' Estimated Valuation—-,
1 hereby affirm that I am exempt from the Contractors, License Law for the following
reason: (Sec. 7031.5,8usiness and Professions Code:•Any city or county which•iequiresa..:
permit to construct, alter,. Improve, demolish, or repair any structure, prior to its issuance also , AMOUNT
requires the applicant for such permit to We a signed statement that hes licensed -pursuant to .PERMIT
the provisions of the Contractor's License taw, Chapter 9 (comammcoig with Section 7000) of .'
Division'3 o/ the Business and Professions Code, or that.he is exempt therefrom, and the.basis ".Plan `
-. for the alleged exemption. • Any violation of Section� 7031.5 • by 'any applicant - for a permit • • Chk. Dep. • - • • ^ ' •- > = • ^r.
subjects the applicant to a civil penalty of not more than five hundred donars ($500). - -- _
,' ❑ I; as owner-of,the property; or m employees:with wa es as their sole com Plan. Chk. Bal.
Y9. pensation,.will _ 3
do the work; and the structure is not intended or offered for sale. (Sec:. 7044, Busness and • Const.
Professions Code: The Contractor's License Law, does -not apply. to an. owner of property who i• •,
`builds or improves thereon and who does such work bursal/ w• through his own erryloyees,-
provided that.such improvements are not untended or offered for safe: If, however, the b�addogMebh.
or improvement is sold within one year of completion. the owner-badElectrical
der will have the burden 3
of proving that he did not build or umprova for the purpose o1 sale.) . • _
- O I, as' -owner of the property, am exclusively contracting with licensed.contractors to con•. ' 'Plumbing - - 30. 00: '
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law -
does not apply to an owner o/ property: who .buIJ&-or Improves thereon,- and. who contacts for S.M.I: ' • such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) '
.'
,• O -I am exempt underSec- w, 8 p -a Grading for this reason ,
Driveway Enc. ,
Date Owner Inffastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to.self-insure, or a certificate of
Worker's Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.) • _
Poli```cy'No. Company '
y�Copy is filed with the city.. ❑ Certified copy is, hereby fumished: '
r ` -TOTAL 30.00
CERTIFICATE OF EXEMPTION FROM - REMARKS
..WORKERS' COMPENSATION INSURANCE
,(This section need not be completed if the permit is for one hundred do0ars (S 100) 'vahraticrr
or less.) - R� ,{ �(� SiI certify that in the performance of thq'work for which this permit is issued, 1 shall not 4 c�(g6�T[��+i.�l0; 2'3ty �,S ql-;tr,
employ any parson in any manner so .,to become subject to the Workers' Compensation - - - - -- - •-• .• •- •• - -
i
Laws of California ti
Date Owner
NOTICE TO APPLICANT: I/, after makbrg this Certificate of Exemption your.•should -become ZONE: ' ' - BY: -
'subect, to the Workers'
comply with such provisions oo thispemJtshagbedeemedrevok� �' �'��r�'��"�`th -Minimum Setback Distances: -
Front Setback from Center Line
CONSTRUCTION LENDING AGENCY'
Ihereby 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 property 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 applicantDate
Mailing Address
City, State, Zip
Rear Setback from Rear Prop. Line
Side Street Setback from Center -Line
e Side Setback from Property Line
-FINAL DATE INSPECTOR
Issued by: Date Permit -
Validated by:
Validation:
i
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING; FEES
1ST FL. SO. FT. $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO, FT. ®
CAR P. I 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRYTRAY
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
VENTILATION
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.
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 SIGNATURES/INITIALS
GARDEN WALL FINAL