002178 (BLCK)44
P.O. BOX 1504 No.. 002178
Building 78-105 CALLE ESTADO
Address 5.-01147 Oak Twe LA QUINTA, CALIFORNIA 92253
Mailing
Address :-15-ws ommtry club
City Zip Tel.
. Palm �vt 92260 1 568 -nm -3 .
Contractor
Address ..
BUILDING:. TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description PM V .'RMW 8 A
City
Zip.
Tel..
- -- -
Sam
State Lic.
City
Side Street Setback from Center Line
& Classif.
28913A
Lic. #
h
Sq. Ft:lin
o. No. Dw.
NStories
INSPECTOR
"-
Size •
. Units
Arch., Engr.,'
Validation:
Designer
New Q 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.. ! ` p
SIGNATURE ".rt ..Q '. DATE
..
..
OWNEWBUILDER DECLARATION
1 herebyaffirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
�e ' •I •��
S� i
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
y
-
requires the applicant for such permijto file a signed statement that he is licensed pursuant to
..• PERMIT -
AMOUNT
the provisions of the Contractors- License Law, Chapter 9 (commencing with Section 7000) of
'
Division3 of the Business and Professions Code, of that. he is exempt therefrom; and* the basis ..
'any for
Plan; Chk. Dep.
'
for the alleged exemption. Any violation of Section 7031.5 by applicant a permit.
' subjects the applicant to a civil penalty of not more than Nve'hundred dollars ($500).
Plan Bal.
D /
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
.Chk.
•.9
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and w
Const.
-
Professions Code: The Contractor's License Law does. not apply Loan owner of properly 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
or improvement is sold within one year of completion,- the owner -builder will have the burden
Electrical
of proving that he did not build or improve for the purpose or sale.) -
0 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.
-.
.95 '
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading
❑ 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
0 Copy is.filed with the city. O Certified copy.is hereby furnished.. .
TOTAL 173037
CERTIFICATE OF EXEMPTION FROM NtMAHKS
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: 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 city to enter the above-:
mentioned property for inspection purposes.
Signature of applicant ' t r ' Date—
Mailing
ate Mailing Address
City, State, Zip
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 Permit
Validated by:
Validation:
A482,
3 18 17337 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS `
SLAB GRADE
2ND FL. SO. FT. ®
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT. ®
OTHER APP./EOUIP.
DRINKING FOUNTAIN
SO. 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, TEMIPERM
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
GAR. FIREWALL
SO.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 APP./EOUIP.
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
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
,