003884 (RR)Building
Address
Owner
Address
City
4 4v � Q14
P.O. BOX 1504
48-880 Eisenhower 7&105 CALLS
LA OUINTA, CALIFORNIAORNIA 92253
John Vann
1y. 0. Box 2351
Zip Tel.
2 7 71 Executive Drive
City - Zip -
Palm Spring 92262
State Lic:
& Classif. 297a6g
Arch:, Engr:,-
Address
325-7200
City < a�
Lic. #
Tel.
;ity I Zip I State
Lic. #
_ CICENSED.CONTRACTOR'S DECLARATION .
1 herebyy affirm that I am' licensed under r-bvIaions of Chapter (commencing with Section
7000) of Dlrsion 3,o the Business and Professions Code, and, y'Ilcenae is infull force and
effect.. .n '�.,
No.- 003884
BUILDING: TYPE CONST. _.00C: GRP.
A.P.-Number,�1'"�21"��%2
Legal' Description
Project Description
Re—roof
Minimum Setback
requires: the appkcent: for such permit. to Me a signed statement that he -is licensed pursuant :to
PERMIT '
the provisions of the Contractor's License Law, Chapter•8 (commencing -with Section 7000) of,
Sq. Ft.
Size -
No. No. Dw.
Stories- Units
New ❑ Add ❑
Alter ❑., Repair ❑ Demolition ❑
Plan Chk. Bal. "
❑ I, as owner'of"the property, or,my employees with wages as their sole compensation, will .
do the work; and the structure isnot Intended or offered for sale. (Sec. 7044, Buisness and
Const.
Pio%salons Code: The Contractor's License Law does not apply to an,ownerof.property who
Date 4: 21'f I PPermit
builds or :proven thereon and who does such work himself or through his own employees,
1 �' rt
rJ .. t - -! 6 v t e_..= ...„ 6. DATE
k - .. - - _-
OWNS BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.S,Bus/rtess and Prolesalons Code: Any city or county which requires a
peimit to construct, alter, improve; demolish, or repair any .hachure; pdor..to Its Issuance s/so
Estimated Valuatior
Minimum Setback
requires: the appkcent: for such permit. to Me a signed statement that he -is licensed pursuant :to
PERMIT '
the provisions of the Contractor's License Law, Chapter•8 (commencing -with Section 7000) of,
Divisfod 3 of the Business and ,Professions Code, or that. he Is exempt.'therefrom;• and,the basis -
for Any Section 7031.5, by for
Plan�Chk. Dep:
=.'alleged exemption. violation of any applicant a" permit
subjects the applicant to a cin/ penalty of not more -than five hundred doilara (S50o).
Plan Chk. Bal. "
❑ I, as owner'of"the property, or,my employees with wages as their sole compensation, will .
do the work; and the structure isnot Intended or offered for sale. (Sec. 7044, Buisness and
Const.
Pio%salons Code: The Contractor's License Law does not apply to an,ownerof.property who
Date 4: 21'f I PPermit
builds or :proven thereon and who does such work himself or through his own employees,
Mech.
provided that such Improvements are not Intended or•oftered'for sale. If, however, the building
Validation:
or Improvement is sod within one year of complegon,- the owner -builder will have the burden
Electrical
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-
[]I'
Plumbing
struct the project. (Sec.. 7044, Business and Professhns Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
S.M.L.
- such projects with a contractor(s) licensed pursuantto the Contractor's License Law.) - -
Grading
❑ 1 am exempt under Sec. B. 3 P.C. for this reason "
Driveway Enc.
Date Owner I Infrastructure
WORKERS' COMPENSATION DECLARATION
I 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
O. Copy is filed with the, city. O Certifled copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATIONINSURANCE
(This section need not be completed if the permit Is for -one hundred dollars (S100) 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: 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,sucn provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby 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 abuildingpermit where properly 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 all cityend 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
Mailing Address
City, State, Zip
HARD COPY
TOTAL
REMARKS
$4,350
AMOUNT
$50.501
s 50
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback4rom Center. Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued -by:
Date 4: 21'f I PPermit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS
SEWER OR SEPTIC TANK
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. 0
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEQUIP.
DRAINAGE PIPING
CAR P. I SQ. FT. ®
TEMP. POLE
WALL SO. FT. ®
GROUT
DRINKING FOUNTAIN
SQ FT ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
c$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
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
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
GAR. FIREWALL
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® IV4 c
SEWAGE DISPOSAL
MESH
SO.FT.GAR ® 3Ac
HOUSE SEWER
INSULATION/SOUND
GAS PIPING
PERMIT FEE
FINISH GRADING
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 PLUM13ING
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 APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
c$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS,
GARDEN WALL FINAL,