002729 (BLCK)..,:ONo. 002729
P.' -BOX 1504 '
Building 78-105 CALLE ESTADO
Address 55-970 PaWle Lvach LA QUINTA, CALIFORNIA 92253
Owner I
y
Mailing BUIL• DING: TYPE CONST. OCC: GRP.•
-
Address 81-937 Sierra Avenge A.P. Number
City Zip JTel.
Indio 92201 MM 368-2629 Legal Description
Contractor Project Description Pmt 1:6 CCnSt11=t .320' of block
Desi HIC. Inc.
Address d3i11 �s Uar PIM.
82--575 Avenm 62
City _ - -
Zip
Te'L
92274
339-11.40
State Lic.
City
& Classif: 463684
Lic. # 5512
Sq. Ft.
No. No. Dw.
•
Size
Stories Units
- .. ..
Arch., Engr.,
. .
Designer
New O Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. # _. .
_,• _ LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter'9 (commencing with Section.
%0) of Division 3 of the Business and Professions Code, and my license is in full force and '
effect.
_SIGNATURE DATE
_
OWNER -BUILDER DECLARATION
EStlmated• Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
¢1�y �y�y -'
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires -a
h1Ul Viii!
.1 '
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
Division 3 of the Business and Professions Code, or that -he isexempt therefrom, and'the basis
for the alleged exemption. Any Section 7031.5 by 'any for
Plan Chk. Dep.
'
violation of applicant a permit
' subjects the applicant to a -civil penalty of not more than five hundred dollars ($500).
Plan. Chk. Bal.
- S 44.52/,�,
. 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, Buisness and
Const.
�a
50Law.
_ Professions Code: The Contractor's License Law does not apply to an owner of property who
-own
•
builds or improves thereon and who does suchwork himself or through his employees,
Mech.
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
Electrical
'
of proving that he did not build or improve for the purpose of sale.)
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
0 Lam exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date Owner A
Infrastructure
nivestigatIm.
68.50
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.
TOTALZ.E�3
_
CERTIFICATE OF EXEMPTION FROM
REMARKS
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: If, after making this Certificate of Exemption you should become
ZONE: -
BY: '
subject to the Workers' Compensation provisions or the Labor Code, you must forthwith'
comply with such provisions or this permit shall be deemed revoked.
MinimumSetbackDistances:
F ont S
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 purposes.
Signature of applicant' Date
Mailing Address
City, State, Zip
HARD COPY
r e ac . rom enter. Ine—
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line,
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date d - -✓ Permit
Validated by:
Validation.
A6819 11 C5 82(15 U
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. S0. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
SCAR P. S0. FT. ®
WALL SQ. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
I SHOWER
BOILER B.T.U.
SO. FT. ®c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1'/a c
SEWAGE DISPOSAL
SO.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.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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL :d