003509 (PLBG)Building 47-x'4.30 Eisenhower
Address
Owner
Co X3 Ford (ijin Dick
Mailing
Address
City Zip Tel.
valler.y . i=lumb i1ng compa
Address
46-700 Clinton Strut
City Zip Tel
_ State Lic:
& Classif" - . 273088
Arch.; Engr.,
Designer
Address
Lic. #
Tel.
P.O. BOX 1504
78-105 CALLE ESTADO
LA-QUINTA, CALIFORNIA 92253
t)
$-
No. 003509
BUILDING: TYPE CONST. M OCC:.GRP.-
A.P. Number 1 eft GUinta t`Wif ES'i atas
Legal Description
Project Description De5lace tdTid4'?raround tic` s
lime Irom -me'ter to houses 601
101 , Sq. Ft.
Size -
No. No. Dw.
Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition O
City Zip State
_ Lic. #
LICENSED,CONTRACTOR S DECLARATION.,_
I hereby
affirm -that I am licensed under provisions of Chapter'9 (commencing with.sectlon
-1 of Dlvislon 3 of tPe Busines rand Pro ssions Code, and my license Is in full force and
�<<„
NATl1RE Y DATE
OWNER -BUILDER DECLARATION E
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 clty or. county. which requires s.,
permit to. construct, alter, Inprove, demolish; or repair any structure, prior to' its issuance also
requires the applicant for such permit to file a signed statement that he Is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
DlvisiorP 3 of the Business and Professions Code: or that. he Is exempt_ therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by -any applicant for a permit
subjects the app/loant to a civil penalty of not more than ftva huindred dollars (5500).
0 I; 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. (Sec. 7044, Buisness and
Professions Code. -The Contractors License Law does not apply to an owner of properly. who
builds orbnproves thereon and who does such work himself or through his own employees,
provided that' such improvements are not intended or offered for sale. If, however, the, building
or Improvement is sold within one year of completion, the owner -builder will'have the burden
of proving that he did notbulld 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. 4044, Business and Professions Coder 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:)
El am exempt under Sec. B. 8 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.)
Poli1yNo. 2 ; r }cJ ? C�mpany
❑.Copy. is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION. INSURANCE
(This section need not be completed it the permit 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 "—Owner
NOTICE TO ,APPLICANT: If, 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 it work thereunder is suspended for 180 days.
I car tify.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'rof this city to enter -the- above-.
mentioned property for inspection purposes:
Signature.of'appllcant Date
Mailing Address
City, State, Zip
HARD COPY
sti,mated Valuation
L PERMIT- AMOUNT
Plan Chk. Dep.
Plan Chk. Bala
Const.
Mech.
Electrical
Plumbing
wt3 , SEI
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 f rom, Property. Line
FINAL DATE
INSPECTOR
Issued.by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUG (Z/(, �r
METER LOOP
GAR. SO. FT. ®
POWER OUTLET'
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SQ. FT.
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN
SQ FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
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
LAUNDRY TRAY
AIR HANDLING'UNIT CFM
FIRE ZONE ROOFING:
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
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 Y. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3,c
HOUSE SEWER
FINISH GRADING
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
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 (ROUG (Z/(, �r
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 x$
=$
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 SIGNATURESIINITIALS.
GARDEN WALL FINAL