11060 (PAT)P.O. BOX 1504
Biilding 78-105 CALLE ESTADO
Address 48-235 Vista De Nopal LA QUINTA, CALIFORNIA 92253
Alfred Krome
Mailing
AJdress Same
C- ty Zip Tel.
. i a guinia 92253 564-2663
Contractor
Owner/Builder
Address. .
C y Zip Tel.:
State Lic.I City
& Classif. Lic. #
Aptly, Engr.,
Designer
Address •► Tel
CZy( Zip ( State
Lic. #
LICENSED, CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7600) of Division 3 of the Business and Professions Code, and my license is in full force and
elfect.
SICNATIIRE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
pesnit to construct, atter, 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
Diwslon 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
su✓Jetts the applicant to a civil penalty of not more than rive hundred dollars ($500).
$� 1, 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, Buisness and
Pr.-fessions Code: The Contractor's License Law does not apply to an owner of property -who
buds 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 wig have the burden
of Droving that he did not build or improve for the purpose of sale.)
1614 AL1 I as owner of the property, am exclusively contracting with licensed contractors to con -
the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of propertywho 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. T P.C. for this reason
Daoe7^/�� 1'1 Owner !Y447 421 11 "
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Norker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
�Policy No. ,Company
�lrCopy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM '
WORKERS' COMPENSATION INSURANCE
(Tvls section need not be completed if the permit is for one hundred dollars ($100) valuation
ordess.)
I certify that in the performance of thg work for which this permit is issued,•( 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: ff, after making this Certificate of Exemption you should become
sLbJect to the Workers' Compensation provisions of • 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
wok for which this permit is issued. (Sec. 3097, Civil Code.)
LeAder's Name
Le-eder'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.
Icertify 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 purposes.
Signature of applicant Date
MEHing Address
Ciy, State, Zip
BUILDING` TYPE CONST
Number
No. Yloso
OCC: GRP.:
Legal Description
Project Description
Enclose Patio
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter Repair ❑ -Demolition ❑
Estimated Valuation
—"1—r6*&--4-eof7 / /j�
7
PERMIT
Plan Chk. Dep.
AMOUNT�,G
e
Plan Chk. Bal.
Const.
%. 0
Mech.
`� 15.00
Electrical
18.78
Plumbing
�..—;
S.M.I.
s-Ar�-
Grading
Driveway Enc.
Infrastructure
4,f:
,f!r'1Sz.J?'1 ��{� �#4(3G" �}LE1' i,Q7.-.•. �rs,;�
TOTAL
REMARKS r
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:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO, FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
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
FLOOR DRAIN
MECHANICAL FEES
—
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR - SUSPENDED
Z
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ic
HOUSE SEWER
-
FINAL INSP.
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. S
Z
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
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL