003045 (PLBG)Building — =::( 4-0, , V i` id,,q
Address �' — a -
Owner
Paul i J'ai,ACe StetT
Malling
Address 2_ 040 Avenida Vallejq
City Zip Tel.
Contractor
.3raAtSCpf %yu ��,cec�w
Address
Zip I Tel.
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City I Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am Ilcensed under provisions of Chapter 9 (commencing with Section
7000)t.of pivision 3 of the Business and Professions Code, and my license is in full force and
effec
SIONATURr DATE
OWNER -BUILDER DECLARATION
I her affirm that I am exempt from the Contractor's License Law for the following
reason; (Sec- 7031.5,BuMbess and Professions Code. Any city or cpurity which requires a
permfl to construct, affer. Improve, demolish, of repair any structure, prior to as issuance also
rnpuhas the applicant for such permit to [Na a signed statement that ho is Ilcensed pursuaril to
the provisions of the Confri ctor's License Law, Chapter a fcommencfng wkh Section 7000) of
Divlston 3 of rho susmess and Professions Cade, or that he is exernp! thsraffam, and the basfc
for the alleged oxempfkrrr. Any WWaticrl of Section 7031.5 by any appA=f for a permit
subjacts the applicant to a civilpenafty of not mare than live hundred dolars fS500).
1 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. (Sac. 7044, Buisness and
Professions Code. The Contractor's License Law does nor apply to an owner of property who
builds of improves thereon and who does such work himgalf or thfough his own ampfoyoes,
provided that such Improvements Are not Mlandad or offered for sate. Jr. however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he dki not bulld or hnprove for the purpose of sale.)
❑ I, as owner of the property, am exclusively cpntracting with licensed contractors to con-
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
utech pibjecls with a coofractor(s).ficansed pursuant to the Contractor's i-kense Law.)
0 1 am exempt under,Ssc B. & P.C. for this reason
Date Owner
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.)
1 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: il, after making this Certificate of Exempfion you should become
subject to the Workers' Compensation provfstans of the ,Labor Code, you must forthwith
comply with such provisions or this pernOr shaft ba deemad revoNed-
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 190 days.
I certify that I have read this application and state that the above Information is correct.
I agree tb comply with all city and County ordinances and state laws relating to building
construction, and hereby authorize representallves Hof this city to enter the above -
mentioned property for inspectlon purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
HARD COPY
No. OC-3045
BUILDING: TYPE CONST, OCC. GRP.
A.P. Number
Legal Description
Project Description :° _
Sq. Ft.
Size
No. No. Dw.
Stories Units
New EX Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep,
Plan Chk. Bal.
Const.
Mech.
Electrical
■
Plumbing
S.M-I-
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
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 4Permit
Validated by:
Validation:
E7729 4 .10 26Go- Tl
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
1ST FL. SO. FT. ®
2ND FL. SQ. FT_
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P, SQ. FT. ®
WALL SO. FT. ®
SQ. FT.
ESTIMATED CONSTRUCTION VALUATION
$
UNITS
YARD SPKLR SYSTEM
IMOBILEHOME 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
LAUNDRY TRAY
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.
SQ. FT. ® c
BATH TUB
SQ. 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
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE
PL.CKFEE
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./EQUIP.
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
O
�� ,
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
4�
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURE&INiTIALS
GARDEN WALL FINAL