9688 (PLBG)78-162 Haciftda
Owner
AIKEN
City lZip 92253 Tel.
ATJa Quinta
Ecano Sewer
P. 0. Box 192
4 No.
,P.O� BOX 1504
78-105 GALLE ESTADO
LA QUINTA, CALiFORNIA,92253
BUILDING: TYPE.CONST.—OCC. GRP,
City Zip Tel.:
Palm Desert 92261 346-2793
State Lic.
& Classif. 460981 # 342
Arch., Engr.,
Desianer
Address I Tel.
city Zip State
Lic. #
LICENSED CONTRACTOWS DECLARATION
I hereby affirm that I am licensed undg provil , slorks of Chapter 9 (commencing with Section
of Division 3 of the Business and Pr4likistons Code, and my license In
PII force and
.§IGNATURE A4
OWNER -BUILDER DECLARATION
I r hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after. hnprove, dernotah, or repair any structwe.. prior to Me Issuance also
requires the applicant for such permit to Me a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Low, Chapter 9 (commencirV 1!vfth Sectbn 7000) of
Division 3 of the sualnesS Land Ptolessions Code, or that. he is exempt thefshom, and 00, basis
for the =%ad=
, ;r: "Dcn"Any violation of Section 7031.5 by= for a permit
SiAwta. a penalty.of not more Own Ove hundred d
q 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 for4als. (Sec. 7044, Sulan-ess and
Prolesildris Code: The Contractor's License Low does nou apply to an owner of Prop" who
builds or= thereon and who does such wo* hNnseff or through his own employees,
provided irnprovements are not Intended or offered fbr�safe. 9, however, the building
or, briprovement Is sold within one year of completion, do owrw-bugdw w.117 have the burden
of proving, that he did not build or Improve for the purpose of safe.)
0� 1, as owner of the property, am exclusively contracting with -licensed contractors to con-
struct the project. (Sec. 7044, Business and Pmlesskm Code., The Conbactorls�Ucense Law
does not'apply,to an,owner of property -who bukh or briproves thersonand-who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec.�B. & P.C. for this reason
Date Owner
WORKERV COMPENSATION DECLARATION
Worklehereby affirm that I have a certificate of consent.to self-insure,'or a certificate of
r's Compensation Insurance, or a certified copy -thereof. (Sec. 3800, Labor Code.)
Policy No,
Company
nCopy Is filed with the city. 0 Certified copy Is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATION INSURANCE
(This section need not be completed ff Me pem* is for one hundrW dollars t$100) vakiabon
or less.)
I certify that In the performance of thIrwork for which this, permit, Is I I asued, I shall not
!Tpioy a ygrso" In any manner so as to become subject to the Workers' Compens4tion
w of & orni.
Da r
No N, after mab7g M Cefilkale of Exemption you should become
subject . 6 the ft'hkers' Compensation provisions of the I Code, you must forthwfth
comply with such provisians or this permit shall be downed mm~.
CONSTRUCTION LENDING AGENCY
I I:reb affirm that there Is a construction lending agency,for the performance of the
work I ww
,ch t is permit is Issued. (Sec. 3097, OW code.)
Lender Nam
Lender': Add 8
This is a building
it the= when properlyr filled out, sIq!ted and validated, and Is subject to
expiration work rz Is suspended for 180 days.
I dertity,that I have read this application and state that.the above Information-Isscorrect.
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 I , nspection purpose&
Signature of applicani -Date
�Malling Address
City, State, Zip
Number
Legal Description
Project Description
Sewer -Hook Up
Sq. Ft. No. No. Dw.
Size Siories Units
New El Add 0 Alter 0 Repair El �Demolition 0
PERMIT
AMOUNT
Plart Chk. Dep..
Plan Chk. Bal.._
Const.
Mech.
Electrical
Plumbing
30.00
S.M.I.
Grading
Driveway Eric.
Infrastructure
TOTAL
30.00
REMARKS
ZONE BY:
Minimum Setback Distances:
—Front Setback from Center Lin
Rear Setback from Rear Prop. Line
Sid&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
IST FIL SO. FT. a $
UNITS
COLL AREA
2ND FIL SO. FT. @
YARD SPKLR SYSTEM
POR. SO. FT. 0,
MOBILEHOMESVC.
BAR SINK
GAR. SO. FT. 0
POWER OU`rLET
ROOF DRAINS
CAR P. I SO. FT. 0
DUCT WORK
DRAINAGE PIPING
WALL SO. FT..@
DRINKING FOUNTAIN.
SO. FT. a
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALLIATION $
WATER PIPING
NOTE.'Not to be used �aSr 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
GRADING
cu.yd.
S -Plus-xt
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FINAL INSP.
KITCHEN SINK
AMORPTION SYSTEM. BJ.U.
TEMP USERERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLF, TEWPERM
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 a 1 'A c
SEWAGE DISPOSAL
SO.FT.GAR @ 3Ac
HOUSE SEWER
SPARK ARRESTOR
GAS PIPING
GAIL FIREWALL
PERM EE
I PERMIT FEE
LATHING
TOTAL FEES
MICRO FEE
MECH.FEE PLCILFEt
I CONST. FEE ELECT.FEE
SMIFEE PLU
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
VSEWER OR SEPTIC TANK&fr3
4 f ROUGH WIRING.
DUCT WORK
ROCKSTORAGE.
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.
S -Plus-xt
LUMBER GA.
FINAL INSP.
FRAMING
FtNAL tNSP.
ROOFING
REMARKS: -
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAIL FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC,
FENCE FINAL
INSPECTORS SIGNATURESANITIALS
GARDEN WALL FINAL