003896 (PAT)W__4� Of • WMFCAV
P.O. BOX1504 No. 003896
Building l .�.. r ,,, 78-105 CALLE ESTADO
Address -V1-- if3 i ,_ru�2s_:t rlt c~ Dr2fL'AQUINTA, CALIFORNIA92253
Owner
Mailing -
Address Deep C
a YQID or,
City _ Zip Tel.
F al m T)e-,art 92 .I60
Contractor
G3i+rll?y ��t3f.1:3�'r
Address
City jZip
State Lic. I City
& Classif. Lic. #
Arcil., Engr.,
Designer
Address I Tel_
City I Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed 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.
SIGNATURE. DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the fallowing
reason: (Sec. 70.31.5,13usiness and Professons Code: Any city Or oounly which requires a
permil to construct, attar, Improve, demolish, or repair any structure, prior to Its Issuance also
requlrss the applicant for such permit to We a signed stalement that he is licensed pursuant to
Me provisions Of the Conlraclar's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the BusMuss and Professkrns Code, or that he is exempt therefrom, and the basis
for The alleged exemption. Any vfolallon of Section 7031.5 by any appkant for a perms
SUNWts the app6canf to a chit penalty of not more than five hundred dollars 19500]-
r7 1, as Owner W 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. (Sac. 7044. Bulsness and
Professions Code. The Cont+aclor'. License Law does nor apply to an owner of property who
builds or knprovas thereon and who does such work himsEN or through his own employees.
provided that such Improvements are not intended or offered for sate. If, however, the building
or Improvement is sold within one year of completion, the owner•buActur will have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Busfness and Professions Cede: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contraclor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B, & P.C. for this reason
Date Owner f -
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.
CERTIFICATE OF EXEMPTION FROM
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 thg work for which this permit is issued, I Y.liill not
employ any pperson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT. 0, after making this Ca#flicee of Exempl?on you should become
subject to the Workers' Comperrsatforl provisions of The Labor Code, you must forthwith
comply with such provisions or INS permlf 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 properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I eertity that I have read this appiicatlon and state that the above information is correct -
I agree tocomply wlth all city and county ordinances and state laws relating to building
construction, and hereby authorize representalives of this c11y to enter the above,
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zlp _
BUILDING: TYPE CONST. OCC. GRP.,
P. Number rya Csuinta Palms
Legal Description
Project Description Patio Cover
Sq. Ft.
Size
No. No. Dw...
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition C
Estimated Valuation
''i50.r
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.1.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: ey:
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:
HARD COPN
T
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
1ST FL. SQ. FT. @
2ND FL. SQ. FT. ®
POR. SQ. FT. @
GAR. SO. FT. @
CAR P. SQ. FT. @
WALL SQ. FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION
$
UNITS
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
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
WASH ER(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, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. @ c
BATH TUB
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE
LPLCK.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
ROCKSTORAGE
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
V
•�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUftES[INITIALS
GARDEN WALL FINAL