003449 (RPL)QUM&
P.O. BOX 1504 NQ. 00,3449
Building 78-105 CALLE ESTADO
Address 55-355 Oak Hill LA QUINTA, CALIFORNIA 92253
Owner
czM"!ri ptm 1t'mm An -o BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address 75_405 Country tub Dr_ _ A.P. Number VGA Wr co$
City Zip
S?2i-@ Tel. ;� 82, Legal Description
Contractor Project. Description
Address
68--455 Perez Foe
" City
Zip
Tel.. .
Cath Yat C5
tv 92234
628-2681
State Lic.
City
& Classif. .'. S7Q6
Lic. # 64
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
u
I hereby affirm that I am licensed under provision's of Chapter 9:(commencingwith Section
7000) of Division 3 of the Business and;Professioos Code, and,my.license i full force and '
din
+
effect..',.}'•.. .riiJ t �ti `�rFiKu�T"c,�9�-'a`....� _: ^• ,
SIGNATURE' - /' - - DAT
OWNER -BUILDER DECLARATION
Estimated Valuation
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
°'A to f9 fS t?4 .
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
"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 the'refio"m, and the basis .
Any Section 7031.5 for
Plan Chk. Dep. ..
for the alleged exemption. violation of by any applicant a .permit
' subjects the applicant to a civil penalty of not more than live hundred dollars ($500). •
Plan Chk. Bal..
-
A Q1 '� 2
❑ I, as owner, of the property, w 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 anda
Const.'
Professions Code: The. Contractor's License Law does not apply (o. an owner of property who
builds or improves thereon and who does such work himself or through his own, employees,
Mech..
provided that'such improvements are not Intended or offered for sale. 1f,, however, the, building'
or improvement is sold within one year of completion, the owner -builder will have the burden
ElectricalAAo/
proving that he did not build or improve for the•purpose of sale.)
O I, as owner of the property, am exclusively contracting with.licensed contractors to con-
Plumbing
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 projec!s with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading
0 1 am exempt. under Sec. B. & P.C. for this reason
Driveway Enc.
Date owner
Infrastructure
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 No. Company
❑ Copy is filed with the city.. ❑ Certified copy is hereby furnished.
TOTAL?
>x
• CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS'. COM PEN SATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) valuation
or less.)
certify that in the performance of thg work for which this permit is issued, I shall not
' •'
f sl+ i 3.t ). 4.;] ":i . b i +i- 14`• --IQ
employ any person in -any manner so as to become subject,to the Workers' Compensation
; :,NSY� i ! F i #!r, F �.e .
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
ZONE:
:BY:
subject to the Workers' Compensation provisions of the' Labor Code, you must forthwith"
Setback Distances:"
comply with such provisions or this permit shall be deemed revoked.
Minimum
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 Name
Lender's Address
FINAL DATE
INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it 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:
Datel n /11 t'R Permit
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.
Validated by:
Signature of applicant Date
Mailing Address _
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPIEQUIP.
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
WASH ER(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, TEM/PERM
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 APPIEQUIP.
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
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL