9455 (PLBG)78=211 Hacienda
Owner
Mr. B
Mailing
Address Salve
City
La. Quints 1, 92653
Contractor
Val ev P? umbiiicT
P. Oa. Box
State Lic.
i£ Classif. C36 273688
Arch., Engr.,
Designer
Address
T4ht 4 4v,49
P.O. BOX 1504
78-105 CALLE ESTADO .
LA QUINTA, CALIFORNIA 92253
# 101
State
Lic. #
LICENSED•CONTRACTOWS DECLARATION
I,hereby affirm that I am licensed under provisions of Chapter 9 (oommencing with Section
of blvlslon 3 of the Business and.�[W.essions Code. and.. my license is immi force and
est. �✓ i _ f , �✓' �.�- 4,s1'.'��. `� ""' -
I NATURE DATE.
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from thwContractoreCkense Low for the following
reason: (Sec. 7031.5;Busbass and Pmfesslces Code: Any city or .qty -r'Nch requires a
perm* to construct, alter, lmprove.-daroc*sh, or repair any, structure, prior to *s./ssuirme also
requires Me applicant for such permit to W a atatement,diet he Y Licensed pbrsuwd to
Me provlebm of the Contractor' ticense Law, er 9 (corrulhoncbhg wO Seddon 7000) of.
Oihlskm 3 of Me Business end Rofessions.Code. or Mat. he Is exarrildR thmelrom, and the tresis
tom the alleged exemption. Any vioistion of Section 7031.5 by -any, N dfemd for a permit
subjects the applicant to a cNa perefty.of not more Men fire hundred dollars (*500).
U I, as: owner of. the, property, or my. employees with wages as thefr_sole compensation, will
clo•the,Work,,andahe structure: is.nobinterhded'or offered (orsele. (Sec. 7044; Budeness and
Professions Code: The Contractor' License law does not appy to an owner of property who
bulide or &proves thereon and who does sigh worfr hkaW or through his ,own employees,
provided that such hwrovernents are not intended of offered #or sob. d, however, the building
or lmproveirierrt !s -soM w*htrr one year of conWkthn, the owner -0u lder w®.haw Me burden
of provhrg that he did not budd'orlrnprove him the purpose of sale.) -
O I, as owner of the property, am exclusively contract rig with licensed contractors to con-
struct the project (Sec. 7044, Businessand Professions Code: The ConbactwIs License Law
does not applyto an ownerofproperty who builds or enpmres thereon; .and who conbads for
such projects;, with a eontraetor(s) Bcensed pursuant to the Contractor' 1./cense Law.)
E1.1 -am exempt under Sec B. 6 P.C..for this reason
Date Owner
WORKERS' COMPENSATION DECLAMATION
I hereby affirm that I have a, certificate of consent to self -insure, or a certlficate'of
Workers Compensation Insurance, or a certified .copy.thersof.1 1..3800, Labor Coude.)
Poll No Comparry t. J I r� .
�pY Is filed with the city. ❑ Certified copy is hereby furnished
CERTIFICATE OF EXEMPTION FROM _
WORKERS' COMPENSATIOWINSURANCE
(This.sectbn need not be completed 9 the permit is for one hundred doners (*100) valuation
or less.)'
1 certify that in the performance of the work for which this permit is Issued, 1 shall not
Laws of Cayllfc rson In any manner so as to become subject to the Workers' Compensation
a.
Date Owner
NOTICE TO APPLICANT: ff, after nab this CeMRcate of EkenWdon you should become
suiOct to the Wbrkere' Compensation _ proWswns of the Labor Code, you must fbowM
comply wf hA such provW&m or.dds perm* aced be doomed remkod. .
CONSTRUCTION LENDING AGENCY
Ihereby affirm that .there We construction lending agency for the performance_ of the
work
for which this permit WIssued. (Seo. 3087; Civ* Code.)
Lenders Name
Lenders Address
This Is a.building permit when props filled out, signered 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
1 agree to compiy'with all cittyy a�nd county ordinances and state lams relating to building
construction; and hereby autlwrtW representatives -of this city to enter -the above..
mentioned property for Inspection purposes.
Signature of applicant Date
Mailing Address_
City, State, ZIn_
FW -WW WW
No. 9455
BUILDING:. TYPE CONST.
A.P. Number
Legal Description
Project Description
SOHER HOOK UP
OCC: GRP.-
Sq. Ft. No.
Size Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑. Repair ❑
Demolition O
Estimated Valuation
PERMIT,
AMOUNT
Plan Chk: Dep.
Plan Chk. Bal.
Const..'.
Mech'. "
Electrical
Plumbing
30-00
S.M.I.
Grading
Driveway Enc.
Infrastructure.
TOTAL
30.00
REMARKS
,3. ��"``- ����'�I� 1 `i �4��€tL.v �s•� .i .r"- � ��Z t}(1 i• t.�
ZONE: BY:
Minimum Setback`Distances:
Front.Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
SidwSetback from.Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES,
NO. PLUMBING FEES
IST FL SO. FT. ® E
UNITS
COLL. AREA
2ND FL. SO. FT.
YARD SPKLR SYSTEM
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. 0
SEWER OR SEPTIC TANK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF:
DRAINAGE PIPING
CARP SO FT ®
HEATING (FINAL)
OTHER APPJEOUIP•
WALL SQ -FT.
DRINKING FOUNTAIN,
SO FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE:, Not tobe used as property tax valuation
FINAL.INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM. FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR, SUSPENDED
FINAL INSP.
LAUNDRY TRAY
AIR.HANDLING UNIT CFM
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
FIREPLACE
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. Fr..RESID ® 114 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Ac
HOUSE SEWER,
GAS PIPING
PERMIT F_ EE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATINGA AIR GOND. SOLAR -
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
OUGH 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:-
EMARKS:VENTILATIONFIRE
VENTILATION-
FIREZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION --q
CERT. OCC:
FENCE, FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
7d