14421 (RPL)4'4 Q r
P.O. BOX 1504
BuildirIAddress 7'"J ® _VIA l 412 1t�.6? LA OUINTA, CALIFORNIA 92253
Owner Manner C6nst.X'UCti02z
manlny
• Address P.O. BOX 1504
City lZip
JTeI.
Palm.Deselrt, . .92211 346.-4289
Contractor
Call fornix Pooh:, and Spas
Ad PS910 16oarftalk, SUite .-,- 2
"Palm De; ert, 92261
State Lic. C--53 185102
& Classif. .
Arch:,'Engr:,
Designer
Address
City 355 '
LIC. #
Tel.
City Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION..
I hereby m affirm thaty;alivense �under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Busing�s and Professions Code, and my license is in lull force and
effect. !✓
BUILDING: TYPE CONST. 'OCC: GRP.
A.P. Number
Legal Description
Project Description i�oU1, �nd a
Sq. Ft. No. No. Dw
Size . . - Stories Units
New ❑ Add. ❑ " Alter ❑ Repair ❑ .
Demolition ❑ '.
g
• SIGNATURE 1 y DATE
'
OWNER -BUILDER DECLARATION'
I hereby affirm that I am, exempt from the Contractors License Law for the following
Estimated Valuation g q pnn
reason:. (Sec. 7031.5,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
I -
.. PERMIT AMOUNT
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 isexempt 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 rive hundred dollars (8500).
O I, as owner of the property, or.my employees with wages as their sole compensation, will
.
Plan Chk'. Dep.
Plan Chk. Bal. 93.60
A
COnSt. 1°3'4-. 00
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
2 4 . a "
builds or Improves thereon and who does such work himself or through his own employees,McCh.
provided that such improvements are not intended or. offered for sale. If, however, the building
,
Electrical -�;�- '
• or Improvement is sold within one year of completion,, the owner-builderwill have the burden
of proving that he did not build or improve for the purpose of sale.) -
Plumbing 27.00
°
b I, asowner of the property, am exclusively contracting with licensed contractors to con-
strucl 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
S.M.I. -
' such projects with'a contractors) licensed pursuant to the Contractor's. License Law.) -
❑ I am exempt under SecB. 8 P.C. for this reason
Grading
Driveway Enc.
Date Owner
InfraStrUCture
WORKERS' COMPENSATION DECLARATION
I hereby, affirm that I have "a certificate of.consent to self -insure, or a certificate of
m
Worker's Copensation Insurance, ora certified copy thereof. (Sec. 3800, LaborCode.)
Polic. df Company
Copy is filed with the city.. .O Certified copy is hereby furnished.
TOTAL 333.60
CERTIFICATE OF EXEMPTION FROM
• WORKERS' COMPENSATION INSURANCE •• ' '
REMARKS
.
(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 thq 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.
e
Date Owner
. NOTICE TO APPLICANT. H, after making ,this Certificate of Exemption• youshould 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:
�' ZONE:- BY: ' -
Minimum Setback Distances: ,
Front.Setback from Center Line
Rear Setback from Rear Prop.. Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL; AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES.AND CIVIL FINES UP TO ONE
Side Street Setback from Center Line
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TOSHE COST OF. COMPENSATION, .- -
e
Side Setback from PfOpejt� e, ,
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. t - -
i
1
FINAL DATE INSP
�'
• _ 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 slate laws relating to building
construction, and hereby authorize representatives -of. this city .to enter the .above•.
mentioned property for inspection purposes:
Issued by: Date fTllt
?fi
Validated by: \
Signature of applicant Date
_ .. Mailing Address
n
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP.IEOUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
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
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 ® 11/. c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ae
HOUSE SEWER
LATHING
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
v
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESlINITIALS
GARDEN WALL FINAL