001990 (RPL)P.O. BOX 1504 No,. 001990
Building 78-105 CALLE ESTADO
-Address SSw LA QUINTA, CALIFORNIA 92253
Owner
:-
BUILDING: TYPE CONST: OCC: GRP.'
Mailing
Address 75-005 OM=tty Mb t1riVe
A.P. Number
City Zip Tel.
palm tea- 'Z Legal Description
Contractor Project Description'
Address . -
City ..... Zips Tel.. T
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
. - ....
Size Stories - Units
Arch.,-Engr:,
Designer,_ New ❑.- Add ❑ Alter ❑ Repair ❑ *Demolition.El,
Address Tel.
City Zip State
Lic. # - _
_ LICENSED CONTRACTOR'S DECLARATION1'++
�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
SIGNATURE i`5. f DATE
- f
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation
reason: _(Sec. 7031,5,Buslness and Professions Code:, Any city "or county which requires a
permit fo construct, aftersimprove, demolish, or repair any structure; prior to its issuance also
requires th-e 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 3of 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 . Plan Chk. Dep.
—subjects the applicant'to a civil penalty of not more than'five hundred dollars ($500).- -
-• 0 1, as owner of the pioperty, or my employees with wages as their sole compensation, will Plan Chk: Bal..
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and COhS,t.
Professions Code: The Contractor's License Law does. not apply to an owner of property who
builds or improves thereon and who does such work himself'or through his own employees, Mach. i
provided that suchimprovementsare 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 - 35.00
of proving that he did not build or improve for the purpose of sale.) - .
0 I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
slruct 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.) -
Grading
0 1 am exempt under. Sec. . B. & P.C. for this reason
Driveway Enc.
Date..' Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
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.. .O Certified copy is hereby furnished.
_TOTALJ•
CERTIFICATE OF EXEMPTION FROM ..REMARKS
WORKERS'.COMPENSATION.INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.) .. -. -
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 ZONE: BY: -
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. -
Front Setback from Center. Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from. Center Line
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
This is a building permit when properly filled out, signed and validated, and is subject to
FINAL DATE _ INSPECTOR
-
expiration if work thereunder is suspended for 180 days. - �'"ii" Lli7
I certify that I have read this application and state'that the above information Is correct. Issued by.:Date ��7 Permit +�
I agree to comply with all -city and county ordinances and state laws relating to building y'
construction, and hereby authorize representatives -of this city to enter -the above-.
mentioned property for„_inspection purposes. .;. Validated :
Si b nature of applicant •� r ! +` ✓� ='� ' j y
9 PP ' ' Date
Mailing Address `, '� Validation:
City, State, Zip
A3780 1 '9 35,GG CK
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. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
I ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP./EQUIP.
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.000L 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, TEM/PERM
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.
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 fELECT.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
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 SIGNATURE311NITIALS
GARDEN WALL FINAL