6876 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO`
Address 44-180 Qwtiiio Drive- LA QUINTA, CALIFORNIA 92253
Owner
Address 4„ flrfr c } Z
City Zip Tel.
Palm Desert 922613 345--7541'
Contractor
Address ...
Tela
State Lic. + City
8 Classic- $#(1( ( $93919 Lic. # 1231
Arch., Engr.,
Designer
Address Tel.
City(Zip I
State
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 Contractors License Law for the following
reason: (Sec. 7031.5,tArssness and Professions Code: Any city or county which requires a
permit to constnict, after, I prove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Conbactors License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the aileged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the appGpnt to a civilpenally of not more than five hundred dollars (8500).
❑ 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
Professions Code: The Contractors License Law does not apply to an owner of property who
builds or approves thereon and -who does such work himself or through his own employees,
-provided that such kniarovements 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
of proving that he did not build or improve for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting 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
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec 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
Workers 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 ff the permit is for one hundred dollars (8100) valuation
or less.)
1 certify that in the performance of the work for which this permit is issued, 1 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: t, after making this Certificate of Exemption you should become
subject to the Workers' cortpensation provisions of the Labor Code, you must forthwith
comply with such provisions or lids 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.)
Lenders Name
Lenders Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 160 days.
I certify that I have read this application and state that the above information is correct.
1 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
No.
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number Tract 24517 -- P-mcho Ocotillo
Legal Description
Project Description Plash: 3s ill, Lot 1
REMARKS ��yy t yy, L pp
XV td`A!76y7ZYtlrtr+��"�#� i"14) . "3 I
ZONE: BY:
Minimum Setback Distances:
Front, Setback -rom Center Line
Rear Setback f -om Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
1f17190
Issued by: Date Permit
Validated by:
Validation:
Sq. Ft.
Size 2550
No.
Stories
No. DW.
Units
New ❑ Add ❑
Alter C
Repair ❑ Demolition ❑
Estimated Valuation
$136,890
PERMIT
AMOUNT
Plan Chk. Dep.
$25.00
Plan Chk. Bali
�§ 389.73
Const.
769.00
Mech.
65.50
Electrical
136.57
Plumbing
150.50
S.M.I.
9.59
Grading
Driveway Enc.
Infrastructure
3,080.03
TOTAL
$4.857.92
-1 4 tit 1, r
REMARKS ��yy t yy, L pp
XV td`A!76y7ZYtlrtr+��"�#� i"14) . "3 I
ZONE: BY:
Minimum Setback Distances:
Front, Setback -rom Center Line
Rear Setback f -om Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
1f17190
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SQ. FT. ® $
2ND FL SO. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. FT.
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
v f 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
STORAGE TANK
FLOOR DRAIN
MECHANICAL FEES
DUCT WORK
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
REINF. STEEL
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE,TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
1AMPERES 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/. c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
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 00
ROUND PLUMBING, p�� UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 3 7 O
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. �
AS (ROUGH) �(arj� - METER LOOP
(
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
00F GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR. FINAL INSP. ��� 26 "
FRAMING/( �� AL INSP.
ROOFING (�(� ��'
VENTILATION
FIRE ZONE ROOFING,
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING i9ty
MESH
INSULATIOWSOUND
FINISH GRADING
FINAL INSPECTION $ —fib
CERT. OCC.
ccurc c�uw�
t,,I p y ,/ �1
S/1 // 100
/ �/
REMARKS:
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL