12069 (RPL)T-11dy 4 4 QUM&
P.O. BOX 1504 N o . 12069
Building 78-105 CALLE ESTADO
Address 73-595 8ottlebRusath LA QUINTA, CALIFORNIA 92253
Owner
Mark SV-0 l-,1 L
Mailing BUILDING: TYPE CONST. OCC. GRP.
Address
A.P. Number
City Zip Tel.
..h v �(� q.!Z 5 -(0,7 Legal Description
Contractor SRO,
Project Description
Address
City Zip Tel.
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip 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.
HE OATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Cantra7tnr'a License Law for the f4ltbwing
mason: A.
7081.5,8u6iness and professions Code: Any city or county which requires a
permit to construct, 2115r, Improva, demoitsh, or repair any structure, pear to its lssuanae also AMOUNT
requires the applicant tar each permit to file a signed statemsM that he Is Licensed pursuant to PERMIT
the provisions of the Conlracrar's OCerrsq Law, Chaplet 9 (commencing with Sgctlon 7000) of
Dwsfon 3 or the BnJlness and ftlessiow Cade, or that he is exempt therefrom, and The basis
for the alleged exemption. Any viaiatlon of section 7031.5 by any applicant for a purruk Plan Chk. Dep.
subjects the applicant to a efvil penally ct not more than five hundred dollars (S600).
r,,77 1, as owner of the property, or my empiayees wits, wages as their sole compensation, will Plan Chk. 881. a-Q
do the work, and the structure is not Intended ar offered for We. (Sec. 7044, Suaness and COf1St. 54.00
Professions Code: The Confractor's License Law does net apply to an owner of property who
builds or improves !hereon and who does such work himgalf or through his own employees, Mech. ���
provided that such improvements are not intended or offered for sale- it, however, the builorIM �+
or improvement is sold within one year of completion, the owner-bOldor WN have the burden Electrical �7s ��
of provinp that he did not build or knptova far the PUW54 of sate.J
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing Z74 0D
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 anprovff� thereon, and who contracts for S.M,I,
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec B. & P.C. for this reason'
Grading.
Driveway Enc.
-Date Owner l Infrastructure
WORKERS' COMPENSATION DECLARATION
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.
TOTAL I `dS AID
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S100) valuation
or less.)
I certify that In the performance of thq work for which this permit is issued, I shall not l 0 CF+�I I. 4�
employ any person in any manner so as to become subject to the Workers' Compensation
Laws d F Ca l if p rnl a.
Date Owner
NDrICE TO APPLICANT..- lf, aftermaking this Certificate of Examphan you should become ZONE BY.
subject to the Workers' Compensation provkiQ?m of the Labor Code, you must forthwith
comply with such provisions or this parmll shall be deemed ievoked- Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) Side Setback from Property Line
Lender's Nama
Lender's Address FINAL DATE INSPECTOR
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 Issued by: Date Permit
I agree to Comply with all city and county ordinances and state laws relating to building
construcliont and hereby authorlre rep rose ntative4 of this city to enter the above -
mentioned property for Inspection purposes. Validated by:
Signature of applicant Date
Mailing Addres Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
1ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @
SO. FT. a
SO. FT. @
SO, FT. @
SQ. FT. @
SQ, FT. @
SQ. FT. @
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
WASHER(AUTO)(DISH)
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.
SO. FT. @ c
BATH TUB
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.0
SQ. FT. RESID @ 14/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DEL
TOTAL FEES
MICRO FEE
MECH.FEE
PL.CK.FEE
CONST. FEE
ELECT. FEE
SMI FEE
PLUMB. FEE
STRUCTURE PLUMBING FI FrTRlrAI HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING ��I y
0 UNDERGROUN
ZZ
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.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
9-cu. yd.
$ plus x$
_$
LUMBER GR
FINAL INSP."
FRAMING
FINAL INSP.✓ �J3ej,
[f
/
ROOFING
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REMARKS:
VENTILATION
FIRE ZONE ROOFING(
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTIQN i
CERT. OCC.
FENCE FINAL
INSRECTOR'S Sf[iNATURES1fH1TfAL5
GARDEN WALL FINAL