9569 (PLBG)P.O. BOX 1504
No. 9569
Building 7$-225 HACIENDA (DE LA QUINACC
Address ALFORNIA92253
Owner
PAT ROSS
Mailing
BUILDING; TYPE CONST. OCC: GRP.,.
Address SA11E
A.P. Number
-City Zip Tel.
LA QUINTA.C® 192253
Legal Description
_
Contractor
Project;Description
SEWER HOOKUP
ECONO SEWER SERVICES
Address
P O BOX 192
QftLI4 DESERT 11C ip 92250 TeL 346-2793
�e— aI#ees es
~-
.State, Lic.-
City
& Classif. 480964
Lic. }l 342
Sq. Ft.
No. No. Dw.
Size
.
Stories Units
Arch., Engc,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ -Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'SDECLARATION.
I hereby affirm that I am Iicensed.undar pro.o'lons of Chapter!D (commencing with.Section
71100) of Division 3 of the Bu al PT,1,9 ipns Code, -and my license Is In full force and
effect. �� ` �
"
SIGNATURE i DATE
OWNER -BUILDER DECLARATION
I hereby affir)n,that I am exempt from the Contractors License. Law for the following
reason: (sec. 7091.5.�ress and".Pro/esaors Code: Any city or count/ whits requires a
permit to construct, after. i nprore, damotiah, or repair any,structure, prior to as ice dao
requires Me appawd for such permit to Ise a signed statement that he is 8cehsed puasu "t ro
the provkhtns.of Me Contractor's Lkense Law, Chapter g (commencing with section 7000) of
DM&tn'. 9, of Me Sushosq and Professions Cede. or Mat. he le • exempt Merehom, and Me' heals
for Me a0eged exerripaoo. Any, violation of Sector; 7031.5 by 'any applicant for a psrmR
suW0013 Me aPpacenu ro a chi peneiy of not more than five hundred doava,(s50o).
❑ 1, es:owner of the pfopertY, or; my employees with'wages as their.,sote compensation, will
do the work, and the structure is not Intended or offered for sale. (Sec. 7044, Bularess-and
Roressions Cade: The Contactors License Law does not appy to. an owner of property who
buddy or Inproves Maroon and who does such work himself or through his own employees.
prortded Mat such 6nprovenrents are not Intended or offered for sale. If, however. the g
or trrprovwriont' h' solo wroth one year of compietlon, the owner -builder wN hors Me burden
. of prov4mg Me 'I:S not build or Improve for the purpose of sate.)
❑ I,.as owner of the property, am exclusively contracting with. licensed contractors to con
struct the project: (Seca 7044, Bushoss and Professions Code: The Contractors License Law
- doea not appy ro an owner of properly *who brdfda or improves Maroon, and who contacts for
���� pmJeds wltlr a drontactar(s) licensed pursuant to'the Contractor's 'Lena Law.) .
❑ 1 aexempt under Sec B. 3 P.C. for this reason
m
Estimated Valuation
$ 1 1500
PERMIT
AMOUNT
Plan Chk..Dip;
plan C.hk. Bal.
C.Onst. .
. Mech.
Electrical
Plumbing
$30.00
S.M.I.
Grading
Driveway. Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I herebyaffirmthatII have,a cartiflcalteeaodf�ccoonns�ie�nnt to.steeiaf-cInsure, or "a certificate of
V t�11Arolr, V i 3800,.Laiior Code.)
�o d l 210 In.2 . or a
❑ Copy is filed with the city. ❑ Certified copy' Is hereby furnished.
TOTAL
$ 30 a OO
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
i !� i =i:. l i ; 1 ! 1 fa i s � ` C7 . 60
(This, Section need not be "completed If Me permit Is for one hundred dopers ($100) va k amn
certify thatAwthe performance of thg work for which this permit is Issued. I shall not
emplq any ppeeBon In any manner so as to become subject to the Workers' Compensation
Laws of ca ,Fe
Data_ twiner
NOTICE TOAPPLICANT: If, after maift this Certificate of Exemption you Should became
su6/aat to Me wMirars' Canvensetlm Provisions of Me Labor Code, you roust (wthwat
comply'with Such provisions or this'permn shall be doomed rewked.
ZONE BY:
Minimum Zetback Distances:
Front.$etback from Center Line
Rear Setback4rom Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Slde Streeet Setback from'Center Line
Ihereby affirm that there Iwa construction lending agency for the performance of the
work for which this permit is -issued. (Sec. 9087, Chi Code.)
Side Setback from Property Line.
Lender's Name
Lenderrs AddressFINAL'DATE
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 alt -city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter' the -above-.
mentione&property, for inspection purposes.
Issued by-
Valjdated'by:
INSPECTOR
Date Permit _
Signature,ohapplicant Date
Manfng Adder
Validation:
city, state, zip
CONSTRUCTION ESTIMATE
NO- ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. C $
UNITS
SLAB GRADE
2ND FL SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR.. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS,(ROUGH)
DRAINAGE PIPING
WALL SQ: FT.
OTHER APPJEQUIP.
DRINKING FOUNTAIN.
SOFT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM. FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE- DRYER
FINAL INSP.
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.TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SQ. FT: ® c
BATH TUB
SO. FT.,a c
WATER HEATER
MAX HEATER OUTPUT,-B.T.U.
SO. FT. RESID.® 1Vi c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3Ac
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.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 TAN
ROUGH WIRING,
DUCTWORK
ROCKSTORAGE
FOUND. REINF.
GAS,(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 xi
=S
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
a
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING'
FINAL INSPECTION
CERT. • OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL