002211 (SOTB)Buildin
Address 55-470 Gak
Owner
Mailing
Address 75-W5 fmtry i
City I Zip
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I 1GO.Uu '
Contractor.
Front Setback from Center Line
.Address
City
Zip
-.
Zip
State Lic.
Sam
& Classif.Jl,�.�
~�' Permit
Arch.,-Engr:;
Date
-Designer
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
Tel.
4
P.O. BOX 1504 No. -
78 -105 CALLE ESTADO.002211.
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description VIM 9WT .
clty
Lic. # .� ar` Sq. Ft. No. No. Dw.
Size 1,185. 11n 12Sfories-- Units
New Q Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
City
Zip
State
0
FINAL DATE
Lic. #
~�' Permit
. LICENSED CONTRACTOR'S DECLARATION. 5
Date
Validated by:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
Validation:
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
A 5 0 2 1
effect. .x
SIGNATURE ,F !% DATE
OWNER -BUILDER DECLARATION '
L-.
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's. License Law for the following
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reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a.
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.
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile 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 3 of the .Business and Professions Code, or that. heis exempt' therefrom, and the basis.-
for the Any -Section 7031.5 'any for
_
Plan -Chk. Dep.
'
alleged exemption. violation of by applicant a .permit
subjects the applicant to a'civil penalty of not more than rive hundred dollars ($500).' '
Plan Chk. Bal.2r�
❑ 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
'. COr1St-
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,
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 of sale.) .
❑ 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.L. - - -
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
.
Grading
_n7
❑ I 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
O Copy is filed with the city. ❑ Certified copy is.hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'.COMPENSATIONINSURANCE
(This section need not be completed i1 the permit is for one hundred dollars ($100) valuation
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.
' Dale 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
Ihereby'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 propert� or inspection purpossess.. "
Signature of applicant v /�+ .j �� ^^ ^� " Date
Mailing Address
City, State, Zip
_ f
' 1 HARD COPY
TOTAL21*i ,?
REMARKS
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
0
FINAL DATE
INSPECTOR
~�' Permit
Issued by:
Date
Validated by:
Validation:
A 5 0 2 1
4 3 320.52 R
CONSTRUCTION ESTIMATE -
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SQ. FT.
FOR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. 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.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
LAUNDRYTRAY
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 ® 1+/a 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 APP.IEQUIP.
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 SIGNATURESIINITIALS
GARDEN WALL FINAL