002419 (BLCK)Building 80-575 (Wk
Address TLVe
Mailing
Address+
City Zip
9221
Contractor
-. Nftl �w
Address
City Tzip
Tel.
Tela •
44
P.O. BOX 1504 N o'. 002419
78-105 CALLE ESTADO .
LA QUINTA, CALIFORNIA 92253
State Lic. I City
& Classif. , 2al3o Lic. # 328
Arch., Engr.. .
Designer
Address Tel.
City Zip State
Lic. #
LICENSED'CONTRACTO.R'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. �l ...%Y{ A
SIGNATURE DATE
r SOW NER-BUILDERDECLARATION
I hereby affirm that I am exemp0rom the Contractor's License Law for the following
reason: (Sec. .703 1.5, Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair 'any' structure, prior to its issuancealso
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"ofthe Business and -Professions Code, or that. -fie -is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section' 7031.5 by 'any applicant for a . permit
subjectsthe applicant to a bivil penalty of not -more than five hundred'dollars ($500).
❑ 1, 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. (Sec7 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.) - -'
❑ I, 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.) -
0 1 am exempt under Sec. B. & P.C. to -r 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
❑ 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 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
subject '10 - 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 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 property for inspection purposes.
Signature of applicant1 r �� �• Date
Mailing Address rr" "
City, State, Zip i
BUILDING: TYPE CONST. ' OCC: GRP.
A.P. Number
Legal Description
Project Description PMXIMM 10 A
�' HARD COPYI .
ZONE:
BY: -
Minimum Setback Distances:
Front Setback from Center Line
Sq. Ft.
Size 442 •
No. No. Dw.
ftstories Units ' -'
New OX. Add ❑
Alter ❑ - .. Repair ❑
Demolition ❑
Side Setback from Property Line
FINAL DATE
INSPECTOR'
Issued by:.
Date 6-16" S611P it
Validated by:
Validation:
A581%
6 17 ;5343 Ch
Estimated Valuation
PERMIT
AMOUNT
Plan'Chk: Dep..
Plan, Chk. Bal..
bit.
Const. '
92.50
Mech.
Electrical
Plumbing
S.M.I.
Al
l
Grading
Driveway Enc.
Infrastructure
TOTAL
Q,
REMARKS
�' HARD COPYI .
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" S611P it
Validated by:
Validation:
A581%
6 17 ;5343 Ch
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. @ $
UNITS
SLAB GRADE
2ND FL. S0. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO, FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APP./EOUIP.
DRINKING FOUNTAIN
SO 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
LAUNDRYTRAY
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
IHOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEECONST.
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./EOUIP.
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
INSULATIONISOUND"
FINISH GRADING
FINAL INSPECTION
CERT. ,OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINIIIALS.
GARDEN WALL FINAL