002417 (BLCK)Tit,
P.O. BOX 1504 No. 002417
Building 78.105 CALLE ESTADO
Address 54-145 Oak H LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. " OCC. GRP.
Mailing
Address 75405 iknaitry club 11r. A.P. Number
City Zip Tel.
. palm � =0 568'2828 Legal Description
Contractor Project Description PM MST PRM 5 A
Address
City Zip ... Tel:.
Sam
State Lic. City
& Classif. 288130 Lic. # 32,3 Sq. Ft. SM 1n. ftNo. No. Dw.
Size Stories Units
Arch., Engr.,
' Designer. New ❑g 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 isin full force and '
effect. d
SIGNATURE `V• r. - 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.
Division 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 applicant to a civil penalty of not more than five hundred dollars ($500). -
❑ 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 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
Estimated Valuation
PERMIT
.Plan Chk. Dep.
Plan C,hk. Bal.,
Mech-. -
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Date Owner I Infrastructure
WORKERS' COMPENSATION DECLARATION
hereby affirm that 1"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. "
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.
Date Owner
NOTICE TO APPLICANT: U, alter 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 permil'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 ' !, e` r G - Date
Mailing Address
City, State, Zip
HARD COPY
AMOUNT
67.92
10440
.95.
IVIHL I I AO d.r4
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
Issued by:
Date's ' Permit
Validated by:
Validation:
A5816
6 17 1 13,37 U
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®'
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT.
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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 ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL .
INSPEGTUN'5 SIUNA I UXES/INITIALS
GARDEN WALL FINAL