05447 (PLBG)J r • ��
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address $9539 Gualaro LA QUINTA, CALIFORNIA 92253
Owner
Wilhelm
Mailing
Address
City
Zip
Tel.
La {iairtre
Lune
No. Dw.
Units
Contractor^
ono Sealer Service
Address
P.0.. BOX 192
City
Tel.
Pam Desert
Jzip
92261
6191346--2793..
State Lic.
City
& Classif. C42-480961
Lic. # 342 _ _
Arch., Engr.,
Designer
Address
Tel.
City (Zip I
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
hereby affiml that I arrlicensed under provisions of Chapter 9 (commencing with Section
7000) of ivisi 1 3 of the Busi anforce,
and
Professions Code, and my is in full forcand
effect �'"
SIGNATURE 4 DATE
-- OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Busness and Professions Code: Any city or county which repuires a
permit to construct, ager, irprove, demolish, or repair any structure, prior to its issuance also
reprices the appOcant for such perm@ to We a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Oivison 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicart to a cw® penally of not more than rive hundred dollars ($500).
❑ 1, 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
Prolassions Code: The Conbadoes 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 irprovements are not intended or offered for sale. If, however, the building
or irprovenrent is said within one year of completion, the owner -builder will have the burden
of proving that he dud 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 coatractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
hereby affirm that 1 have a cerfificete of consent to self -insure, or a(certificate of
Workers Compensation Insurance, or a certifi copy thereof.*,(S®c. 3800, Labor Code.)
Policy No company �. - 'rV i ...t....
❑ Copy is filed with the city. ❑ Certified copy is hereby fumished.
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 shall not
=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 provlsioru or this pemrit 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 abuilding 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.
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. 05447
UILDING: TYPE CONST. OCC: GRP.
.P. Number
egal Description
roject Description SEM 110OK WP
REMARKS
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ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
FINAL DATE
INSPECTOR
Issued by:
Datef61Permit
Validated by:
Validation:
Estimated Valuation
$500. 000
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
20.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
• r
TOTAL
REMARKS
-6, `P tyf%:.$a?i^o-1?tia—�`t':k?,t�ijI:P
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:
Datef61Permit
Validated by:
Validation:
J
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
$
UNITS
IST FL. SO. FT. ®
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
MOBILEHOME SVC.
BAR SINK
POR. SO. FT.
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
DRAINAGE PIPING
CARP. SQ. FT.
DRINKING FOUNTAIN
WALL SQ. FT.
URINAL
SO. FT. @
WATER PIPING
ESTIMATED CONSTRUCTION VALUATION $
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,TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® V/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL TOTAL FEES MICRO FEE
7
MECH.FEE
PL.CK.FEE CONST. FEE
ELECT. FEE
SMI FEE
PLUMB. FEE
GTRUCTURC PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
SLAB GRADE
FORMS
FOUND. REINF
REINF. STEEL
GROUT
BOND BEAM
LUMBER GR.
FRAMING
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCF FINAL
GROUND PLUMBING
ROUGH PLUMB.
SEWER OR SEPTIC TANK
GAS (ROUGH)
GAS (FINAL)
WATER HEATER
WATER SYSTEM
FINAL INSP.
IUR'S SIGNA
UNDERGROUND
BONDING
ROUGH WIRING
METER LOOP
TEMP.POLE
SERVICE
A.C. UNIT
HEATING (ROUGH)
DUCT WORK
HEATING (FINAL)
FINAL INSP.
COLL. AREA
STORAGETANK
ROCKSTORAGE
OTHER APPJEQUIP.
GRADING
FINAL INSP. cu. yd.
$ plus x$ =$
REMARKS:
GARDEN WALL FINAL