001916 (RPL)- A' lit
P.O. BOX 1504 N o . 001916
�
Buildng 78-105 CALLE ESTADO �r
Address JAZZ Oak HM LA QUINTA, CALIFORNIA 92253
Owner
sluirise
BUILDING: TYPE CONST. OCC. GRP.
Mailing.
Address 7S-0115 Cknmtxv CITIb Ems,. A.P. Number
City JZip _ Tel.
.. palm 92260_x$" Legal Description
Contractor
Project Description
Address..
68-465 ft=z Mad
City.. Zip Tela _ .
cam. ( t J92234 328-2681
State Lic. City
& Classif.. r 51 2757CIA
Lic. # 69 Sc. Ft. No. No. Dw.
Arch.; Engr., . -
Size Stories Units
"•Designer New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City[Zip State
_. Lic. #
LICENSED CONTRACTOR'S, DECLARATION
I hereby affirm that I am licegsed undereDrovisions gfaChapter 9`(iiommencing with Section
7000) of Division 3 off/the Business and'P,iofessions-Code,.and=my-license islin full force and
effect.../ �a r YJ
SIGNATURE
SIGNATURE" DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractors License Law for the following ti���Q.�JA
reason: (Sec, 7031,.5, Business and Professions Code: Any city, or county which requires a -
permit to construct, atter," improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to lila asigned statement that he -is licensed pursuant to PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter. 9 (commencing with Section •7000) of • -
Dibision 3 of the Business and' Piofessions 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 -Play Chk. _bep
subjects the applicant to a"civil penalty of not more than five hundred dollars'(S500).' .. - '• - - -
❑ I, as owner of the property, or.my employees with wages as their sole compensation, will Plan Chk. Bal. 64.02
do the work, and the structure is not intended or.offered for sale. (Sec: 7044, euisness and "
COnSt.
Professions Code: The Contractors License Law does not apply to. an owner o/ 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. If, however, the building " q
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical 36.W
ofproving that he did not build or improve for the purpose of sale.)' - __ " '
❑ 1, as owner of the property, am exclusively contracting with licerised contractors to con-. Plumbing 14.00
struct the project. (Sec. 7044, Business and Professions Code: The .Contractor's.License Law _. p
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. AN
such projects with a contractor(s) licensed pursuant to"the Contractor's.License Law.) • .
Grading
.O I.am exempt under Sec. B. &• P.C. for this reason
Driveway Eno.
Date owner Infrastructure
WORKERS' COMPENSATION DECLARATION
Thereby affirm that I have a certificate of cohseht'to'self-insure, or At 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. 0 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
-
orless:) "
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 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 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 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 cit to enter the above
• mentioned property for inspection.purposes.� ,
Signature of applicant �' ` Date /—' ,3
Mailing Address
City, State, Zip
HARD COPY
TOTAL 207.40
REMARKS -
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from.Rear Prop. Line
Side Street Setback from Center tine'
Side Setback from Property Line'
FINAL DATE
INSPECTOR
Issued by:
Date 22^-285 Permit
Validated by:
Validation:
A 3 5 0 7
12 9 x,,7,40 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. Q. 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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/e c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
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 APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
�(JGfi/o %� 3/ (Y6
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 SIGNATURESIINITIALS
GARDEN WALL FINAL