04545 (SIGN)T4t!t 4 44,Q"
P.O. BOX 1504
Building78-105 CALLE ESTADO
Address Fred 'haring 6 Dune FalM s LA QUINTA, CALIFORNIA 92253
Xs8 i. into Associr-&teed
Ing 43-375 Washington Street
City Zip Tei -
Palm Desert 92260 345-7543
Contractor
Martin Ad'i ort.8 "..I' inq _
I IrVina BlVd
BUILDING: TYPE CONST. OCC: GRP.
Number
5t�
.egal Description
)roject Description Slow — )! lure facility
sign constructed of neva material, i
ncludl.
3 and 4" X 411 posto. Surf+i
tin I` gab �34 �i1 i�'�4 i--3d7f Lo>;>rface t�o-ba painted
& Classif
Designe'ro",
Address
City IZipI State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license Win full force and
SIGNATURE -DATE
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Seca 7031.5;Buslness and Professions Code: Any city or county which !e4rdrse a
permit to conatntct. alter, Improve, demodsh, or repair any stricture, prior ro its Isauence afao
requires the spplioam for such permit to'fee a signed statement that he Is licensed pursuant to
the provisions of the Contractor's License Law, Chapter .8. (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or Mat he Is exempt therefrom, and Me. Dealt
for the a0eged 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 (1500);
❑ 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 for sale:.(Sac. 7044, Bufaness and
Professions- Code: The Contractor's License Law does not apply town owner of properly 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 sets. H, however, Me buUding
or brnprovement is sold within one year of completion, Me owner-bu8der w/s have the burden
of, proving that he did not, build or improve for the purpose of sale.)
❑ 1, 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 Lk ense Law.
doesnot. apply to an owner o! property who builds or 'Mnproves thereon; and who contracts for
such projects with a cont=%i(s):Ncenaed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
1
Date owner
WORKERS' COMPENSATION DECLARATION'
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker., Compensatlon.Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company ,
❑ Copy Is filed with the city. 'O; Certified copy is hereby furnished..
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed H the permit Is for one hundred dollars (1100) valuation
or less.)
I certify, that in the performance of ;thp work for which:this permit Is Issued, I shall not
employ any pereon In any manner so as to become subject to the Workers' Compensation
Laws of California.
Dale ---Owner
NOTICE TO APPLICANT:.H, after maMng this Certificate of Exemption you should became
subject to the Workers' Compensation provisions o/ Me Labor Code. you must totownh
comply with such provisions or this permit shaft be deemed revoked.
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. 3087, Chill Code:)
Lender's Name
Lender's Address
This Is a building permit when property filled out, signed and validated, and Is subject to
expiration It work thereunderIs 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 applicant Date
Meiling Address
City; State, Zip
Sq. Ft. 40' No. No. Dw.
Size Stories Units
New ❑ Add O Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$1,000
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const. 4� • 1J
Mach.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
�.-
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 I SPE TOR
Issued by: Date Permit
Validated by:.
Validation:
1
WHITE - FINANCE, PINK -.APPLICANT, GREEN - BUILDING, OOLDENBOD - A88E88011ill's OFFICE, HARD COPY - FILE
CONS TRUCTION'ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT p , S
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING _
YARD SPKLR SYSTEM
2ND FL SO FT. 0
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FTR
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. Q
TEMP. POLE
GROUT
DRAINAGE PIPING
CARP. SO FT. Q
FINAL INSP.
WALL SO. FT. f
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
CU. yd.
S, plus xS
=S
URINAL
SO. FT. M
FINAL INSP.
FRAMING
ESTIMATED CONSTRUCTION VALUATION S
WATER PIPING
NOTE: Not to De.used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
I
WATER SOFTENER
VENT SYSTEM FAN EVAP:COOL HOOD
SIGN
WASHER(AUTOKDISHI
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
LAUNDRYTRAY
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. ® e
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID a 1 W c
SEWAGE DISPOSAL
SO.FT.GAR a %c
HOUSE SEWER
FINAL INSPECTION
GASPIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
i
MICRO FEE
MECH.FEE L.CK.cEE
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 APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
S, plus xS
=S
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP:
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR,
GAR.. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL 71