002049 (BLCK)k
Building
Address ��"�
Owner
� Y
Mailing
Address
City Zip
Part D1i L 9,,,,
Contractor
real
•4 4 "
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Tel.
568-2= .
jZip I Tel.
State Lic.City
& Classif. �? k Lic. #a
Arch., Engr:,
Designer.
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 . f
f 1
SIGNATORE r DATE
f OWNER -BUILDER DECLARATION
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
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permiCto file a signed* statement that,he is licensed pursuant to
the provisions of the Contractor'sLicense Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefroin, and the basis
for the alleged exemption. Any violation of Section 7031.5 by -.'any applicant for a 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
do the work, and the -structure is not intended or offered for sale. (Sec. 7044, Buisness and
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,
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
of proving that he did not build or improve for the purpose of sale.) ._
❑ 1, as owner of the property, am exclusively contracting with licensed contractors 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
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
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.
CERTIFICATE OF EXEMPTION FROM
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.
Dt '
No. 002049
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
,Legal Description
Project Description P 4.= fto.j
r
1A ^" M=8 ^dyad walls
and re= pxlvvxy walls.
Sq. Ft.„
.Size
5416 1”ftStories
No.
No. Dw.
Units
New
Add ❑
Alter ❑
Repair ❑ Demolition ❑
Const...
104.50
Mech.
CONSTRUCTION LENDING AGENCY
Electrical
Side Street Setback from Center Line
Plumbing
S.M':I.
r
.95
Grading
Side Setback from Property Line
Driveway Enc.
Infrastructure
Lender's Address
FINAL DATE
INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
Estimated Valuation
ZONE:
PERMIT
AMOUNT
.Plan Chk. Dep.
Plan Chk. Bal.
67.92
Const...
104.50
Mech.
CONSTRUCTION LENDING AGENCY
Electrical
Side Street Setback from Center Line
Plumbing
S.M':I.
r
.95
Grading
Side Setback from Property Line
Driveway Enc.
Infrastructure
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.
I certify that I have this
;+
TOTAL
173.37
'REMARKS
agree to comply with all city and county ordinances and state laws ielating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
a e 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
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances: -
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. 3097i 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.
I certify that I have this
;+
read application and state that the above information is correct. -
I
Issued by:
Date Permit
agree to comply with all city and county ordinances and state laws ielating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Validated by:
Signature of applicant a J Date
Mailing Address h ti i `k
Validation:
City, State, Zip
A4288
2 18 ; 7337 Sl
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
♦ POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP.IEOUIP.
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
I
IKITCHEN 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.
SQ. FT. RESID ® 1114 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/4c
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.IEOUIP.
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
I NSU LATIONISO U N D
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL