12709 (AR)IIIIIIIIIIIIIIIIIIIIIIIII 48 T4tt
Qum&
IE
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
W.aacv Friedm4n
Mailing Sane
Address
City Zip Tel.
Ir"i +�uint,�, CA 92253
cU!JIN ok/BuiIder
Address
City, Zip Tel.
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer Charlas Martin
Address+`nunderbird Rd, Tel. 0 346--4491
City Zip State
Mirage CA 92270 Lic. # 75
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7tX10) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATuhE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the fDllowing
reason: (Sec. 7t731.5,8usiness and Professions Code: Any city or cmmfy which requires a
Permit to construct, aller, improve, demo+lsh, or rapafr any structure. prior to its issuance disfl
teguirss the applicant for such permit to fife a signed stafemani that he is fcensed.jowsuani to
the provisions of the Contractors tJcem a Law. Chapter 9 ecommyncfng with Section 7600) of
Division 3 of tho Eltmaess and Professions Code, or that he is exempt therefrom, and the basis
lot (ha alleged exsmpilon. Any violation of Section 7037,5 by any applcant tut a permit
subjects The applicant to a cfvif pansky of not more than five hundred ❑oAars fS500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, wlII
do the work, and the Structure is not Intended or offered for sale. (Sec. 7044, sussness and
Professions Code.- The Cdnfractar's License Law does not apply to an owner Dr property who
bulkts or Improves Thereon and who does .such work himself or Through his own employees.
Pravlded that sucli intprorernants are mat lnterrded or ollered for sale. It, however, The building
or Improvoman[ is said Within cne year of completion, the. owner-buildier 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.)
❑ I 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
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy fro 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 if the permit is for one hundred dollars ($100) valualion
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 thls Cenificala of Exemption you should become
subject to the Workers' Comper+setinn provisions of the Labor Code, you must forthwith
comply with such provisions or lhis permll 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 Ni3rrrs
Lender's Addresg,.
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 road thla application and state that the above inforMsdon is correct.
I agree to comply with all clty and county ordinances and state laws relating to pudding
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 173--253--02'5
Legal Description r' =`t If Jx 1 oc i, 10
Project Description {r1S r`-'r' adder t i Ox
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation j r I:1 ; , l
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
HEMARKS
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:
Date Permit
Validated by;
Validation:
I
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO.
PLUMBING
FEES
$
UNITS
1ST FL. SQ. FT. ®
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT.
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT.
DRAINAGE PIPING
CAR P. SQ• FT. @
DRINKING FOUNTAIN
WALL SQ. FT.
URINAL
SQ. 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(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
KITCHEN SINK
AIR HANDLING UNIT CFM
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
POLE,TEMIPERM
LAVATORY
COMPRESSOR HP
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
SQ. FT. @ c
BATH TUB
BOILER B.T.U.
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL TOTAL FEES MICRO FEE MECH.FEE
T
PL.CK.FEE CONST,FEE
ELECT. FEE
SMI FEE
PLUMB.
FEE
STRUCTURE PLUMBING
ELECTRICAL
HEATING
& AIR
COND.
SOLAR
SETBACK
SLAB GRADE dY
FORMS
FOUND. REINF. •
REINF. STEEL
GROUT
BOND BEAM
LUMBER GR.
FRAMING 3
ROOFING ' 6
2VEN/CL T 10
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL 3_0-I 0
LATHING 3 —1�y--jr Ljq
MESH
INSULATION/SOUND 1
FINISH GRADING
FINAL INSPECTION^' q,G
CERT. OCC.
FENCE FINAL
GROUND PLUMBINGa,ti
ROUGH PLUMB.
SEWER OR SEPTIC TANK
GAS (ROUGH)
GAS (FINAL)
WATER HEATER
WATER SYSTEM
FINAL INSP.,- _,4 5 = L D
UNDERGROUND
BONDING
ROUGH WIRING
METER LOOP
TEMP. POLE
SERVICE
A.C. UNIT
HEATING (ROUGH)
DUCT WORK
HEATING (FINAL)
FINAL INSP.
GRADING
FINAL INSPS� cu. yd.
$ plus x$
REMARKS:
COLL. AREA
STORAGE TANK
ROCKSTORAGE
OTHER APP.IEQUIP.
GARDEN WALL FINAL