002583 (SIGN)P.O. BOX 1504 No, 002583
Building5�.'02t0 Ri rwive LA QUINTA CALIFORNIA92253
Address '
Owner
Pred A,i rAs''Iw%h '
ng
City Zip Tel.
.. eta. 92253 564-4104•
Contractor
. . 0"f Sacci Cmft5
,Address .....
+35591 14.1
City lZip Tel. -'
State Lic. City
& Classif. 233809 Lic. # 774
Arch., Engr.;
Designer
Address Tel.
City Zip State
_. ... .- Lic. #
LICENSED CONTRACTOR'S_4ECJLARATION
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 is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby, affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions .Code: Any, city or oounly•whlch requlres.a
• permit to construct, alter, Improve, demolish, or repair any structure,. prior to fts aasuance. 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
Division' 3 of the Business and. Professions Code, or Ghat. 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 applicant to a civil. penafty-of more than live hundred dollars f$500): . -
❑ I, as owner of the property, or my employees with wages as.their sate compensation, will
do the work, and the structure is not. intended or offered for sale. (Sec: 7044, Bulsness and .
Professions Code: The Contractor's -License Law does not apply to an, owner of property 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 sale., n. however, the building
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 ProfessFons Code: The Contractor's License -Law
does not apply to an owner of property whobuilds 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. 8 P.C. for this reason
�:
Date ''Y �:�' Owner _ F � i'ri ��'."�:r•/%/ _.-v-ro� n-s�
WORKERS"COMPENSATION DECLARATION
I hereby affirm'that I have a certificate of consent to self -Insure, or a certificate of
Worker's Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O. Copy Is filed with the city. D. Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(Thissection need not be completed if the permit is for one hundred dollars (sloo) valuation
• or fess:) - -
I certify that in the performance of thg work for which this permit is Issued,.lshall not
-- employ any person In any manner so as to become subject to the Workers' Compensation
Laws of California.
Date ' - owneP
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 pemmit.shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the '
work forwhich this permit is issued. (Sec. 9097,. 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 .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.relatjng to building
construction, and hereby authorize .representatives of, this city to enter the above•.
mentioned property:for inspection purposes.
Signature of applicant' r, r - Dates "✓
Mailing Address.
City, State, Zip
HARD COPY
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal, Description
Project Description
Sq. Ft. No.
Size Sto
New ❑ Add ❑ Alter ❑ '
21
o
PERMIT
Plan Chk. Dep. .
Plan Chk. Bal.
Cohst..
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
No. Dw.
Units
Repair ❑ Demolition ❑
of Approval
�' �Y1�4JnlJii
AMOUNT
.00
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
Issued by:
Date Permit
-Validated by:
Validation:
A6380
9 2.4 U
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. F7.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGEPIPING
CAR P. SQ. FT.
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN
SQ FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION S
=$
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
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
SQ.FT.GAR.® 3/ic
HOUSE SEWER
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 HEATINGA 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 APPJEOUIP.
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
INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL
ALI--
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R 0 W Iq L EIFF,
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LALS &-I- L I A)
jjjNTA
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-OF Dept.
L-r
cb-1- Commullity
CONIMITIONAILLY
T ED
ACCEP
INFTAL
THIS Is AN ORIGINAL UNPUBLISHED DRAWING SUBMIT -TED FOR YOUR.
PERSONAL USE IN CONNECTION WITH A PROJECT BEINC D
FO)R YOtJ BY CHIEF SIGN CRAFTS, IT IS NO11' TO BE REP
"IOFIED EXI'MITED I'CI AHY FAS' iON WITHUT THE Vy'-
C11"IEF SIGN CRAFTS,
Chief Sign Crafts 398-6313 Calif. LIc. No. 233@09
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