002561 (RPL)BuildfsAddres 55-555 le t °l
Owner
�t82ri.�
Mailing'
Address 75-005 Coz-V Club
City Zip
rvulm W 92260
Contractor
C. I. $.8
Address
.City Cft C I ity Zip_. _
State Lic.
& Classif. 275796
P.O. BOX 1504 IVIS.. UU256
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253.
BUILDING: -TYPE CONST. CCC: GRP:
—rive A.P. Number.
ITel.
568„ Legal Description
Project Description
City
Lic. # 69
Sq. Ft. No. No. Dw.
• Arch En r ''•
Size Stories Units'
9 •,
Designer New E� Add ❑ Alter ❑ Repair ❑ ' Demolition ❑ '
Address Tel.
City Zip State 1. fountain
Lic. #
LICENSED CONTRACTOR'S DECLARATION,r
I hereby affirm that I•amllicensed under provisions of Chapter..,9 (commencing -with Section' ^
7000) of Division 3 of the Business•and Professions Code;. and. my license is in full force and
effect. �► �r�� /�.^_ rrl�y - - - _ _
_SIGNATURE W DATE _
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License law for the following . .. ..3xi�s,�.p
171
• reason: (Sec. 7031.5,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 'AMOUNT
requires, the applicant for such permit to rile a signed. statement. that he is licensed pursuant *to . PERMIT, •.
the provisions of the Contractor's License Law, Chapter 9 (commencing with. Section .7000) of
r 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 Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ' ' •- -
O I, -as owner of the property, or my employees with wages,astheir sole compensation, willPlan Chk. BBI. 143.00
do the work, and the structure is not intended or offered for sale. (Sec. 7044,-Buisness and COf1St. Y 6� ��
Professions Code: The Contractor's License Law does• not apply to an owner of. property who s.
builds of improves thereon and who does such work himself or through his own employees, Mech.�
provided that such improvements are not intended.or offered for, safe. If, however, the building . -
or improvement is sold within one year of completion, the owner -builder will have. the burden' I I .
of proving that he did not build or improve. for the purpose of sale.) - E ect rlca
O I, as owner of the property, am exclusively contracting with licensed contractors to con- 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's License Law.)
Grading
O 1 am exempt under sec. B. & P.C. for this reason
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
. .. O. Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS', COMPENSATION INSURANCE
(This section need not be completed ff the permit is'lor 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: If, alter 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.
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 property 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 staie•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 cityoto enter -the above
mentioned property for inspection purposes. , �1+
Signature of applicant j1 + r• �' ✓ Date "r
Mailing Address
City, State, Zip
HARD COPY
. 44sG,. }i�7iJ
2:49
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front. Setback frorn 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:
A6309 9 1U 419,49 CK
of proving that he did not build or improve. for the purpose of sale.) - E ect rlca
O I, as owner of the property, am exclusively contracting with licensed contractors to con- 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's License Law.)
Grading
O 1 am exempt under sec. B. & P.C. for this reason
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
. .. O. Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS', COMPENSATION INSURANCE
(This section need not be completed ff the permit is'lor 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: If, alter 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.
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 property 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 staie•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 cityoto enter -the above
mentioned property for inspection purposes. , �1+
Signature of applicant j1 + r• �' ✓ Date "r
Mailing Address
City, State, Zip
HARD COPY
. 44sG,. }i�7iJ
2:49
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front. Setback frorn 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:
A6309 9 1U 419,49 CK
CERTIFICATE OF EXEMPTION FROM
WORKERS', COMPENSATION INSURANCE
(This section need not be completed ff the permit is'lor 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: If, alter 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.
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 property 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 staie•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 cityoto enter -the above
mentioned property for inspection purposes. , �1+
Signature of applicant j1 + r• �' ✓ Date "r
Mailing Address
City, State, Zip
HARD COPY
. 44sG,. }i�7iJ
2:49
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front. Setback frorn 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:
A6309 9 1U 419,49 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FE -56
IST FL. SO. FT. ® $
UNITS
-
2ND FL. SO. FT. p
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT.
MOBILEHOME SVC.
BAR SINK {-
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT. ®
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER HEATER
SERVICE
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
GRADING
-Cu. yd.
$ plus x$
_$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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.
SO. FT. ® c
BATH TUB
GAR. FIREWALL
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
MESH
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 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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL