001677 (RPL)P.O. BOX 1504 �v N o . 001677
Building 54-,395 War LA QUINTA, CALIFORNIA 92253
Address .
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section '
7000)of DiSision 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 Contractor's License Law for the following
reason: (Sec. 703 1.5, Business. and Professions Code: Any city or. county which requires a.,
permit .to construct,' alter, improve, 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
Division 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 applicant to a civil penalty of not more than flve.hundred dollars ($500). " "
O 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,•Suisness 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
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
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. 7-6-�:�C.ompany S4 r. t r)
Q Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if 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: It, after making this Certificate of Exemption you should become
subject to the - Workers' 'Compensation provisions or the Labor Code, you must forthwith
comply with such 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 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 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 of this city to enter the above-
mentioned property for inspection ppurposes.
Signature'of applican Date
Mailing Address
City, State, Zip
DeS=t Design
Estimated Valuation
000.$0
BUILDING: TYPE CONST.
A.P. Number
Legal Description
Project Description.
OCC: GRP.
14 a 24 1 ;~3zfd Soa
Mailing
Address �!
City
Zip
19".M
Tel.
Contractor
'Lund Carxtx=t1m
Address ..
_
52-010 DiaZ
3-7.50
Electrical
1-2_1110
Plumbing
City
-Z
".ta
ip
92753
Tel:
'.
50.-0026
Driveway Enc.
8 15 J 9),9G CK
State Lic.
& Classif.
C53-475-655
City
Lic. #
_ „ „ -
Sq. Ft..
Size
No. No. Dw.
Stories Units
Arch., Engr.,
Designer
-
New C7 Add ❑
Alter ❑ Repair ❑ . Demolition ❑
Address
REMARKS
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)of DiSision 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 Contractor's License Law for the following
reason: (Sec. 703 1.5, Business. and Professions Code: Any city or. county which requires a.,
permit .to construct,' alter, improve, 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
Division 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 applicant to a civil penalty of not more than flve.hundred dollars ($500). " "
O 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,•Suisness 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
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
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. 7-6-�:�C.ompany S4 r. t r)
Q Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if 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: It, after making this Certificate of Exemption you should become
subject to the - Workers' 'Compensation provisions or the Labor Code, you must forthwith
comply with such 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 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 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 of this city to enter the above-
mentioned property for inspection ppurposes.
Signature'of applican Date
Mailing Address
City, State, Zip
ZONE:
BY:
Estimated Valuation
000.$0
PERMIT-
AMOUNT
Plan.Chk. Dep.
-
Plan Chk. Bal.
".42
Const.
89.50
Mech.
3-7.50
Electrical
1-2_1110
Plumbing
14.0111
S.M.I.
.' I
Grading
Driveway Enc.
8 15 J 9),9G CK
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 from Property Line
FINAL DATE
INSPECTOR
Issued by.-
Date A-1-5-45 Permit
Validated by:
Validation:
A 2 3 2 1
8 15 J 9),9G CK
HARD COPY
T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIN(-GEES e
IST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB. S' j
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOSILEHOME SVC.
BAR SINK
POR. SO, FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SQ. FT. ®
GAS (FINAL)
TEMP. POLE
WALL SQ. 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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES —[—MICRO
FEE
MECH.FEE PL.CK.FEE
TNST. 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. S' j
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING S'
%
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS.
'
GARDEN WALL FINAL
&
Z\
0 .1
Z% go
10
CO
I
,l
P4.
ii
,l
P4.
/U F+O C,-)
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