002730 (SOTB)tress 476654
Owner
Cien mvis
P.O. BOX 1504
78 105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address 74-85A %Te__UG �V
City Zip Tel.
Palm � � � -
%rIdy.l
77-854 Veli - 1'.Rq
State
Cla sl
c.
Bif. 122422 Fuicy#
Arch.; Endr; -
Designer -
Address Tel.
City Zip State
Lic. #
LICENSED CONTRyCTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter'9 (commencing with Section
ef700�t 1 Division 3 of the Business and Professions Code, and my license is -In full force and,
SIGNATURE '• Y DTE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor'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 thea signed statement that he.is licensed pursuant to
the provisions of the Contractors License law, Chapter 9 (commencing with Section 7000) of
Division 3'of the Business -and Professions Code, or that.he.ls 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 Ove hundred "We ($500).'• -
❑ I, as owner of the property, or my. employees with wages as their sole compensatlon; will.
do the•work end the structure is not Intended or offered for.aale: (Sec.' 7044, Buisness and
Professions Code._ The Contractor's License Caw does not apply to an owner of property who.
builds or improves.thereon and who does such work.hkmself or through his own employees,
provided that such improvements are not Intended or offered- for sale. M however, the butlding
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)- _
❑ 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.) -
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
'1 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
❑ Copy is filed with the city. . p Certified copy is, hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATIOWINSURANCE
(This section need not be. completed If the pemoft 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 Owrier
NOTICE TO APPLICANT, N, 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
Ihereby 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 thatA have read this application and state that the above information is correct.
I agree to, comply with all.cityand.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 y` d Date
Mailing Address_
City, State, Zip
HARD COPY
NO. -.002730
BUILDING: TYPE CONST. OCC: GRP:.
Number
,Legal Description
Project Description
Sq. Ft.No. No. Dw.
Sized Stories Units
New ❑X Add ❑ Alter ❑. Repair ❑. Demolition ❑
Estimated• Valuation. 17Q34.57
PERMIT
AMOUNT
Plan Chk. Dep. -
Plan Chk. Bal.
93.152-
30 52.Const.'
Const.,
121.53
Meeh.
13,45
Electrical
Plumbing
36.00
S.M.I.
1.23 •
Grading
Driveway Enc.
FINAL DATE
Infrastructure
Issuedby:
Date Oermit
Validated by:
Validation:
A6.8Z1
11 25 X77,25 Ck
TOTAL
277025
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
—INSPECTOR—'--
INSPECTOR'Issued
Issuedby:
Date Oermit
Validated by:
Validation:
A6.8Z1
11 25 X77,25 Ck
CONSTRUCTION. ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
UNITS
GRADE �� �s
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
1ND FL. SO. FT.
FORMS
SEWER OR SEPTIC TANK
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APP.IEOUIP.
DRAINAGE PIPING
CAR P. SO. FT.
TEMP. POLE
WALL SO. FT,
GROUT
DRINKING FOUNTAIN
SO FT ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION E
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
=E
FLOOR DRAIN
MECHANICAL FEES
FRAMING % 7 Q�
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L 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, TEMIPERM
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 ® 1 Vi c
SEWAGE DISPOSAL
SO.FT.GAR @ 3Ac
HOUSE SEWER
TION/SOUND
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
TT
SETBACK
G ND PLUMBING �a
NDERGROUND
A.C. UNIT
COLL. AREA
GRADE �� �s
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
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.
E plus xE
=E
LUMBER GR.
FINAL INSP,
FRAMING % 7 Q�
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
ESH
TION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC:
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN, WALL. FINAL