08973 (SFD)Building
Address
50-105 Gr�r
Owner
N.J.
BrMk
Mailing
Address
233g E.
City
Zip
I
CAMOnA
t
Contractor
0=ex
Address
City
Zip
State Lic.
& Classif.
412636
Arch., Engr.,
Designer
Address
City
I hereby affirT,that 1
7000) of Division 3 oft
effect. ,
Zip
' u
P.O. BOX 1504
78-105 CALLE ESTADO
s0AoP_ LA QUINTA, CALIFORNIA 92253
City
Lic. # 13
Tel.
State
Lic. #
'TOR'S DECLARATION
visions of Chapter 9 (commencinf
salons CodeAnd my license is in
I hereby affirm that I am exempt from the Cbntractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, 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
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 violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
jf O I, as owner of the property, or my employees with wages as their sole compensation, will
t • 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 himself 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 -builder will have the burden
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-
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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am 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
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
yC py is filed with the city. O Certified copy 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 the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
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, 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 if work thereunder is suspended for 180 days.
I certify that I have read this application and stale 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
BUILDING: TYPE CONST
.P. Number
No. 089,73
OCC: GRP.-
Legal Description
Project Description Nodal I Ut 14w 22
Sq. Ft. No. No. Dw.
Size 2204 Stories Units
New ❑ Add ❑ Alter ❑ Repair O Demolition ❑
r
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical 123.
Plumbing
10;2-
S.
11--44
Grading
Driveway Enc.
Infrastructure 162 1 AA
TOTAL 5357.71
REMARKS tlt3�+#€;�- 3. 4?a°� ii w �–r7i�. ., -.. J40
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
COLL. AREA
SLAB GRADE /Q—/`,—yi
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SD. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT.
GAS (FINAL)
TEMP. POLE
WALL SQ. FT.
DRINKING FOUNTAIN.
GROUT
WATER HEATER
URINAL
SO FT ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
cu. yd.
plus x$
FLOOR DRAIN
MECHANICAL FEES
14NAL INSP.f��-O
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
REMARKS:
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
MESH
SQ.FT.GAR ® 3/ac
HOUSE SEWER
INSULATION/SOUND
GAS PIPING
PERMIT FEE
MIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE EPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
OUND PLUMBI
1, UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE /Q—/`,—yi
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. /5_/O . ?6)
lJ ! CCC///
�,QGAS (ROUGH),
� METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
_$
LUMBER GR.
14NAL INSP.f��-O
AMING _
FINAL INSP.
tjo�ROOFING ,
/,�/• .0 3- r 3 �� �lN —
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
R//LATHING L ``() ^meq,
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL