03971 (CP)4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Afirirpcc 4 n, 499 Eivienhower LA QUINTA, CALIFORNIA 92253
Owner + -
8"`.at'ill 66 Palm Springs
Mailing
Address
City lZip ITel.
Contractor
stove Dodson conot ction _ . _ ..
Address
68-703 Perez Rd.t Ai 1I
City Zip . Tel.
Cathedral Citli 92234 324-21132..,
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number 631-370-021
03�'7.1.
Legal Descriptions
Project Description P2'raso X * moot d
& Classif. a'556{t7 Lic. # iQ-44 Sq. Ft.
Designer
Address Tel.
City I Zip I State '
Lic. #
LICENSED CONTRACTOR'S DECLARATION 1
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 f
effect.
SIGNATURE ! DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Suslness 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
requires the applicant for such permit to file a, signed statement that he is licensed pursuant to
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 is exempt therefrom, and the basis
for the alleged exemption. Any violation of Sectlon 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (E500).
❑ 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 Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who -does such work himself or through his own employees,
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 I 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, 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.0 'for this reason
Date Owner
y
~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.
CERTIFICATE OF EXEMPTION FROM
WO R KERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hundred dollars (E100) 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
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 properly filled out, signed and validated, and Is subject 10
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.
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.
Stories
No. Dw.
New O Add ❑
Alter O Repair ❑ Demolition ❑
/j
i
Estimated Valuation
0M $20 r 170
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
, �J(_ , :,
14b
Mech.
Z0. 09
Electrical
+•
Plumbing
/ e E
.if,41
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
&WWQW1 AR
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
1i/.9 8?,
Issued by: Date Permit
Validated by:
Validation:
.42
. 5C
+.Qc
144
WHITE - FINANCE, PINK.- APPLICANT, GREEN - BIJILDIMG, G0L0ENf100 - •85ES5OR'S OFFICE, HARD COPY - FILE .
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
IST FL SO FT rp
2ND FL SO FT. a
POR SO FT. Cr
GAR SO. FT. Or
CAR P. SO FT. is
WALL SO. FT. 0
SO. FT. 0URINAL
ESTIMATED CONSTRUCTION VALUATION
S
i
UNITS
YARD SPKLR SYSTEM
-
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
$
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP,COOL HOOD
SIGN
WASHER(AUTOXDISH)
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.
SO. FT. ® c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID g 1 V. c
SEWAGE DISPOSAL
SO.FT.GAR (a ri.c
HOUSE SEWER
GAS PIPING
PERM17 FEE
PERMIT FEE
PERMIT FEE
DEL
TOTAL FEES
MICRO FEE
MECH.FEE
PL.CK.FEE
CLNST. 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.IEOUIF.
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. u
ROOFING
REMARKS:
6-
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