002184 (RPL)P.O. BOX 1504 N o . O 21 #
Building 54_290 flakTEW 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. OCC: GRP.-
Mailing
Address 75_O.)5 0M2r1trV Club Drive A.P. Number
City Zip Tel.
Fa .De 92260 36=5-2821 Legal Description
Contractor Project Description 1
Address.. 1 l — � ' i A
68-'455 ci Pool. r- 20 x. 30
City Zip Tela
328-2681 sm - 10 10
mtbjeftW Cil v '92253
State Lic. City
& Classif. • 275796 Lic. # 69 . Sq. Ft. No. No. Dw.
Arch., Engr:,..
Size Stories Units
Designer New ❑X Add ❑ Alter O- Repair ❑ Demolition ❑
Address Tel.
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
O Copy is filed with the city.. ❑ Certified copy is hereby furnished. ,
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (5100) 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.
it
AMOUNT
95.32
146.50
2{ 5.00
i°48 a !00
3 q� wLa�
L 44
300.-26
Date Owner"
NOTICE TO APPLICANT: If, after - making this Certificate of Exemption you shouldbecome become
City
Zip
State
-Minimum Setback
Distances:
Lic. #
'
MINIMUM 6 FT. WK
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 Busin'ess'and-Professions,Code, and -my license is in full force and
effect. _ �.'` ;r e '. ...w... l r'/
-1 EJ AICHI
AW SF
,
SIGNATURE DATE_
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
2000a.�0Q
'�
reason:. (Sec. 7031.5,Business and Professions Code:. Any city on county which requires. a
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 '
the provisions of the Contractor's License Law, Chapter'9. (commencing with Section 7000) of.
�•s
'
Plan Chk. Dep.
' Division 3'of the Business and Professions Code, or.that. he is exempt therefrom,t. and the basis
forthe alleged exemption. Any violation of Section 7031.5 by 'any applicant fora. permit
' 'subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
O. I, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Bal.
Const..
do the work, and the structure is not intended proffered for sale.,(Sec. 7044, Buisness and •
Professions Code.. The Contractor's license Law does not apply to an 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 licensedcontractors 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 improves thereon, and who contracts for
S.M.I. "
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - -•
O 1 a exempt under Sec. B. & P.C. for this reason
Grading
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
O Copy is filed with the city.. ❑ Certified copy is hereby furnished. ,
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (5100) 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.
it
AMOUNT
95.32
146.50
2{ 5.00
i°48 a !00
3 q� wLa�
L 44
300.-26
Date Owner"
NOTICE TO APPLICANT: If, after - making this Certificate of Exemption you shouldbecome become
ZONE:
BY: -
subject to the Workers' Compensation provisions of. the' Labor Code, you must forthwith
-Minimum Setback
Distances:
comply with such provisions or this peimit shall be deemed revoked.
'
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 if work thereunder is suspended for 180 days.
g q ��
I certify that I have read this application and state that the above information incorrect.
Issued by:
- Date •y"'.6' 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 inspect ion`purposes:/ : "'
Validated by:
s
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
A 4 8 0 0 3 1 7 3i;0 26 31
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ, FT. ®
CAR P. SQ. FT.
WALL SO. FT. ®
SQ. 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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPIEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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/e c
SEWAGE DISPOSAL
SQ.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 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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
�nare�, i vn a aiunH � �nwnm i Www,
GARDEN WALL FINAL