003344 (BLCK)4
P.O. BOX 1504 No. 003344
Building 78-105 CALLE ESTADO
Address 55'319 L�ak Hill LA QUINTA, CALIFORNIA 92253
Owner
Mailing
BUILDING: TYPE CONST. OCC: GRP.
Address aAc�di#i C94ipl-git 1 h ^1riisa
A.P. Number
. _ . .. .
West
City -Zip
Tel. .. ,. , -
-gaj}k�
92260
.56716.
Legal Description
.. ,.
PrOjeCJ Description
Black Uall. 175 lin. ft. X 6
Contractor
Nati nnal Land FtMartnane
Address - -. ...
City .. ]Zip
Tela .
State Lic.
& Classif.
City
Lic. # 328
Sq. Ft.
No. No. Dw.
Size
,
-Stories - Units
Arch:, Engr.,
..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. I If r. .. r" % . ,- .,a
SIGNATURE 1 C »' . . _'t. / it f-'ai nk r :. w J l ^'�• / DATE
OWRER-BUILDER DECLARATION
.
I hereby affirm that I am exempt from the Contractor's License law for the following
Estimated Valuation
X
�1 8760
. reason: 7Sec. 703.1. 5, Business and Professions Code: Any.. city or county which requires a
.0
-
-: PERMIT
AMOUNT
"
., pemiR 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 fivehundreddollars. ($500). "•
O 1, as owner of the property, or.my employees with wages as their sole compensation, will
. Plan Chk..Dep.
-
Plan Chk..Bal.
Const:.
' do the•w'ork, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law, does not apply town owner of property who
�Mech.
,
-
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 -
Electrical.
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.) - -
Plumbing
❑ 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 improvesthereon, 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. 8. & P.C:-for this reason
Grading
Driveway Enc
Date owner
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.
TOTAL
REMARKS
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 tha 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 this Certificate of. Exemption you should become
subject to 'the Workers' Compensation pr60isions' of the, Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY: '
Minimum Setback Distances: -
Front Setback from Center. Line
Rear Setback from Rear Prop. Line
. CONSTRUCTION LENDING.AGENcr p
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 Name
FINAL DATE
INSPECTOR
. 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 car Iffy that Lhave read this application and state that the above information is correct.
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.
Issued by:
Validated by:
'9
Date ` �� ' Permit
Signature of, applicant Date
Mailing Address
Validation:
City, Slate, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEQUIP.
DRINKING FOUNTAIN
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
.
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
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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 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
I N SU LATIONISOUN D
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL