002526 (RPL)Building 54-169 0A FIM
Address
Owner -
Address
City
ractor
Aaaress.
68-465 Pam Road
City. _. - - Zip `
44 , 0
P.O. BOX 1504 No. 002526
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: -GRP.
A.P. Number
Tel.
Legal Description
Project Description WA WEM Flklm- 5 A
Tel.'
State Lic.
City
.Minimum Setback Distances:
& Classif,
3. 71110;
Lic..
Sq. Ft.
No. No. Dw.
Side Street Setback from Center Line
Size
Stories- Units
Arch., Engr.,
Issued by:
Date A--7—` f; Permit
Designer
New Add ❑
Alter ❑ Repair ❑ :Demolition ❑
Address
Tel.
A6151
8 i 75,49 �K
City
Zip
State
. .. .
. . .
Lic. # -.
. LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed underlprovisions of Chapter 9_(commencing with Section
7000) of Division 3 of the Business and;Professions;Co_de,,and my ficenseds in full force
effect. ( f'f ° •^ and
SIGNATURE n - DATE
-
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that 1 am exempt from the Contractor's License Law for the following -
11-00
reason: (Sec. 7031,5, Business and Professions Code: Any city or county which requires a
s00
permit to. -construct, after, improve, demolish, or repair -any structure, prior to its Issuance also
requires the;. applicant for such permit to Ole a: signed statement that he is licensed pursuant to
PERMIT
- AMOUNT '
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 Any Section 7031.5 'any for
Plan Chk. Dep..
- ,
alleged exemption. violation of by applicant a:permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ' -
Plan Chk. a.
Bal.
O 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
Const.
FAG
. Professions Code: The Contractor's License Law does not apply to an owner of. property• who , .
�
builds or unproves thereon and who does such work himself or. through his own employees,
Mech:'
'
. provided that such Improvements are not intended or offered for sale. If, ,however, the building
or improvement is sold within one year ofcompletion, the* owner -builder will have the burden
EI2CtrICBF^!�
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-
Plumbing
12—M
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
S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
-
Grading
❑ Lam exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
1 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. O. Certified copy is hereby furnished:
TOTAL
17. 42
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hundred dollars ($400) valuation
-
or less.) .. _ .
I certify that in the performance of thg work for which this permit is issued, 1 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: N, after making this Certificate of Exemption you should become
subjectto the Workers' Compensation provisions of lhe'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.)
Nam
Lender's Nae
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.
1 certity 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 -of this city'to enter the above-
mentioned property for inspection purposes.
Signature of applicant •' .. � Date'
Mailing Address
City, State, Zip j
HARD COPY
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 A--7—` f; Permit
Validated by:
Validation:
A6151
8 i 75,49 �K
CONSTRUCTION ESTIMATE
i NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL SO. FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. I SO. FT.
WALL SO. 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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEGUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.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
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEGUIP.
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
MbFrU I UM"A WtANA 1 UNC511NI 1 IALb.
GARDEN WALL FINAL