08627 (BLCK)Builin
Address 51-960 Elmmhower
OwnerLwdraca T=
' u
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Address 73-625 Ilwy 111 #G
City Zip Tel.
Palmttlewxt 92260 773-3125
Contractor
ress
City lZip I Tela
State Lia I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address
CityI Zip I State
#
i LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
i 7000) of Division 3 of the Business and Professions Code, and my license is in full force and
I 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,Business and Professions Code: Any city or county which requires a
permit to construct, alter, 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
I Division 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
;; b 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
%fbuflds or improves thereon and who does such work himself or through his own'employees,
I . - 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 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 contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
i Date >~e Owner
WORKERS' COMPENSATIO`N•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. 0 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 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Dale 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 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.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Cd�
Wor 08627
WING: TYPE CONST. OCC: GRP...
P. Number
77175-011
Description
t Description .. +
Sq. Ft. No. No. Dw.
Size • Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
mated Valuation
I PERMIT I I AMOUNT
Plan Chk. Dep.
P,Ian Chk. Bal.
Const. 63.00
Mech.
Electrical
Plumbing
S.M.I.
.28
Grading
Driveway Enc.
Infrastructure
TOTAL /C
REMARKS i A.4Iti#.?_ 7f '4 -?�.—fib ,_ ., �3
IV a7
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
Issued by: Date
Validated by:
Validati
INSPECTOR
Permit
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SD. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
FORMS
SEWER OR SEPTIC TANK
GAR. SO. FT, ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
DRINKING FOUNTAIN.
SO FT ®
REINF. STEEL
URINAL
ESTIMATED CONSTRUCTION VALUATION $
TEMP. POLE
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
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
LUMBER GR.
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.
SQ. FT. RESID ® 1Va 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.CK.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
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
REMARKS:
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
pF
R
` A
4+% OFFICE OF >
� AGRICULTURAL COMMISSIONER
1i ` 7;• 4080 LEMON STREET, ROOM 19
'a RIVERSIDE, CALIFORNIA 92501
(7 14) 787.2561
M� Y 91,18 q 7
46-209 Oasis Street, Room 14
Indio, CA 92201
(619) 342-8291 '
Dear Developer/Landscaper:
E. LEON SPAUGY
COMMISSIONER
JAMES O. WALLACE
ASSISTANT COMNUSSIONER
Thank you for inquiring with the Agricultural Commissioner's Office regarding
local quarantine laws.
Any diseases or insects associated with the plants/landscaping material presented
on your landscaping plans do not pose a threat to the Coachella Valley Citrus,
Date, Crape, Vegetable, or Field Crop industry. We therefore approve your
landscaping plans.
If however, any substitutions of plants/landscaping materials within your plans
occurs between now and the actual planting date, you must contact this office
within 48 hours before delivery into the Coachella Valley. Also, the substituted
plants/landscaping material must be held for inspection upon arrival. Any sub-
stituted landscaping material found infected/infested with quarantine pests will
be immediately treated or shipped out of the Coachella Valley at the discretion
of the Agricultural Commissioner's Office,
Under penalty of perjury, I.the undersigned will comply with the above.
Authorized Agent:
Name 6- E41wO-rdAo je-r-�O 1Date %7-- E
Signature_
Permit Numbers) K of _ 5 1.2 / %_C
Developer,,, Address
AGRI CULTURAL C01•24I S SIONER' S APPROVAL`�� Date l 2
Authority cited: Agricultural Code; Sections 6301, 6461, 1[64 1, 6521-
6524 Q`J�i. orb
APPROVED
cc: 2 Plan Check, Indio Office, Riverside Office
BY: cc
y► DATE: Z l =
Form A - 10/84 &HA.L COi�