14860 (RR)Building
Address ss 52-0%0 Eisenhower
Addr
Owner
4
P.O. BOX 1504
78-495 CALLE TAMP.ICO
LA QUINTA, CALIFORNIA 92253
Joseph L. Xazvia
Address PO Bax 6k00
City Zip Tel.
Palm desert 92261
Contractor - tlwne'r/.Builder
Address
City lZip Tel.:
State Lic. I City
& Classif.. Lic. #
.Arch., Engr.-,
Designer
Address Tel.
City - Zip State
Lic-.-#
LICENSED.CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 -(commencing with Section
7000) t. of Division 3 of the Business and Professions Code, and my license is in full force and
effec
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
., reason: (Sec..7031.5,Bustness 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 rile a signed statement that he Is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of .
D)vislon 3 of the Business and Professions Code, or thathe* is exempt therefrom, and the -basis
16r the alleged 'exemption. Any violation of Section 7031.5 by any applicant for a permit .
Vlsir jects the applicant to a civil penalty of not more than five hundred dollars ($500).
aeowner 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 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. If, however, the building .
orImprovement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or 6nprove for the purpose of sale.).
O'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 License Law .
does not apply to.an owner of property who builds or improves thereon, and. who contracts for
such projects with a contractors) (lcensed pursuant to the Contractor's License Law.)
O I amexempt undersSec!: .R. S P.C.-for this reason
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
O 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 i1 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, 1, shall not
employ anyparson in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: 8, 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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE ISUNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS'($100,DD0), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,- INTEREST, -AND
ATTORNEY'S FEES.
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 that 1 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
Mailing Address
City, State, Zip
No. 14860
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Re -roof
Project Description
Sq. Ft.
Size
No. No. Dw.
Stories Units -
New Add -O '.
Alter O Repair O • -Demolition O
Front Setback fro n r Line
Rear Setback fr ar Pr . Line
Side Street fro Line
Side Setb fromW perty e
Estimated Valuation
$1 s 000 00—A
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
[pit
Const.
$30.00
-Mech.
Validation:
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
q 30 , OO
REMARKS
ZONE:
BY:
Minimum Setback
Distances: .
Front Setback fro n r Line
Rear Setback fr ar Pr . Line
Side Street fro Line
Side Setb fromW perty e
FINAL DATE
INSPLVrOR
Issued by:Da
[pit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SO. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CARP. SO. FT.
GAS (FINAL)
WALL SO. FT.
DRINKING FOUNTAIN
SO. FT. ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
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. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Ve c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
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 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.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
/`/�ROOFING
-3 G/ /T
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL