003717 (MISC)P.O. BOX 1504 N Q . AM a 14 1
Building 48-231 Vista Del Nepal 78-105 CA'LLE, ESTADO
Address CA QUINTA, CALIFORNIA 92253
Owner .... .... _.. . ,. ". - ...
Ing
ress Swim
Zip ITel.
L.ontractor
t'''`f Fa34 �� 4)firh� silt
Address .. .. _
1 83-23U0 ElVt•; nue 44
BUILDING: TYPE CONST. OCC::GRP.
A.P=Number LagQmaN Ia Paz
i9453 . Legal. Description
Project Descriptionc1S>
City _. Zip Tel.
Indio
State Lic. City
& Classif.. 419"1 Lic. 11 Sq, Ft.' .
1 1i .Y. . . — ..
.
Arch.; Engr., .... . ,. ..... .. _
_.. .
Size
Designer New O
r
No. No. Dw.
-Stories Units
AddE Alter O' Repair O . ' Demolition O
• Address
Tel.
City
Zip f - ,f
State
r
Lic. # ..
`CIICENSED CONTRACTOR S -DECLARATION
I hereby am under
• affirm that) licensed provision's of Chapter 9 (commencing with Section
7000) of Division 3 of the -Business and Professions/ipode, and'my license 'is -in full force and '
effect.
SIGNATURE •+' , 1/ aiJ::.Gr:,/ ! DATE
- ..
r
0•WNER•BUILDER DECLARATION -
- .. .. _ .•
Estimated.Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
$2
reason: (Sec.- 793 1..5, Business 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
PERMIT AMOUNT -
the. provisions of the Contractor's License Law, Chapter 9'(commencing with Section 7000) of
' ',Division 3. of the Business and'Professlons Code, or that: he is`exempt therefrom, 'and the basis
P'
-Chk:
,for. the alleged exemption: Any violation of Section 7031:5 by 'any applicant for 'a permit
Plan Dep. .
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).'-
Plan Chk.
❑ JI, as owner of the property, or my,employees with wages as their sole compensation, will
,.:do
,Bal.
the work, and -the structure is not intended or offered for sale. (Sec. 7044, Buisness and-
Const.. l UU,
• Professions Code: The Contractor's License Law does not apply to. an owner oL. property who
•own
-
• builds or improves thereon and who does such work himself. or through his employees,.'
MBCh.
provided that' such improvements are .not intended, or offered'for .sale. If, however,: the' building.
or improvement is sold within one year of completion, theowner•builder will -have -the burden
of proving that he, did not build or improve for the purpose of sale.). . ' - ` ,: , '.
EleCtflCal '
611, as owner of the property, am exclusively contractingswith licensed contractors 6,6on=
Plumbing ' '
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
S:M'.I.
such projects with a contractor(s) licensed pursuant to the Contractor'siicense'Law.) -
I
-
Grading
0.6am exempt under Sec. B. & P.C. for this reason
I r
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
worker's Compensation Insurance, or a certified copy thereof. (Sec: 3800, Labor Code.) '
Policy No. Company
❑ Copy is filed with the.city... ❑ Certified copy is hereby furnished. _.. . .
TOTAL
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.) .. -. .. -. ..
certify that in the performance of the work for which this permit is issued, I shall.not}i
_
..i'. �.%I(• '4. J" (7\t
employ any person in any manner so alto become subject to the Workers' Compensation .
Laws of California.
Date Owner '
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
ZONE: BY: • - -
' subject to the Workers' Compensation provisions of -'the Laboi Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:• "
t
Front Setback":from.Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center -Line -
1 hereby affirm that there is a construction lending agency for the performance of the
work for which thispermitis issued. (Sec. 3097, Civil code.)
Side Setback from Property Line
Lender's Name
Lender's Address
{ This is a building'permit'when property filled out, signed and validated,'and is•subjectto
,FINAL DATE. INSPECTOR
expiration if work thereunder is suspended for 180 days.
II certify that I have read this application and state that the.above information is correct. _
Issued by; Date 33 L1f3Permit'
• 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.
Validated by:
Signature of applicant Date
Mailing Address
Validation,
City, State, Zip
1
... ... ... , - _ •.
.l HARD COPY
...
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ, FT, p
GAR. SQ. FT. ®
CARP. SQ. FT.
WALL SQ. Fr. ®
SO, FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
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.IEQUIP.
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 510NATUHESIINITIALS
GARDEN WALL FINAL