002418 (BLCK)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address RO-'459 Oak Wee LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address 75.005 OqWrtzy ClUIr.
CityZip Tel.
..92260- 5613-2828
palm
Contractor
lett]. Mirtgam and L -m -d
Address ..
' City (Zip '
Sam
State Lic.
& Classif- 2888
Arch., Engr:, "
Designer.
Address
Tela "
No.. 002418
BUILDING:- TYPE CONST. OCC'. -.GRP.
A.P. Number
Legal Description
Project Description VA IS PMW 9 A
't ,. -.� t s acs ►' i -
City
Lic. # 323 Sq. Ft.
.Size - f
New ❑x
Tel.
No. No. Dw.
Stories Units
Add ❑ Alter ❑ ' Repair ❑.
Demolition ❑
CityZip
BY:
State
Lic.'# _
Front Setback from Center Line
Rear Setback from Rear Prop. Line
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 a y+ r 7 s
-
-
Side Setback from Property Line
-
SIGNATURE C Y "- DATE
f% OWNER -BUILDER DECLARATION
that I am exempt fromihe Contractor's License Law for the
I hereby affirm13
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 loAts issuance also
requires. the applicant for such permit to/file a signed statement that he Is licensed pursuant to
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. he- is exempt therefrom, 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 or 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 isnot 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 or 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 contractor(s) licensed pursuant to the Contractor's License Law.)* - -
❑ 1 am exempt under Sec. B. & P.C. for this reason
Estimated Valuation
4�
�1i 13,8%.00
PERMIT
,
'
- •� AMOUNT
'
.Plan Chk. Dep..
-
.
Plan ChkBal.;��
,
Const.
�ty„lE1J�n
Mech-
.
.
'
Electrical
,
-
Plumbing
S. M.1.
- .
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
❑ 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.). - -
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.
TOTAL
173.37
REMARKS
- -
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 1 have read this application and state that the above information is'correct.
I agiee'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 ,~ r ��, • ! r Date
Mailing Address
City, State, Zip f
�r
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 6-16'06 Permit'
Validated by:
Validation:
A 5 8 1 5
6 1i ;i337 R
CONSTRUCTION ESTIMATE
NO. ELECTiiICAL FEES
NO. PLUMBING FEES
IST FL. SQ. 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. I SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. 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
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
SQ. 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
ME:H.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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL