002432 (RPL)P.O. BOX 1504 No. 002432
Building78-105 CALLE ESTADO
Address 180--575 Oak TLM LA QUINTA, CALIFORNIA 92253
Owner .
Ma
BUILDING: TYPE CONST. OCC: GRP:-
iling
Address 754-0-5 qwmti%lb Drive A.P. Number
City Zip Tel.
PA -.SIM. 929th) .. 545R--2828 Legal Description
Contractor Project Description
G.'R. TIMI omistructim
Address .
68-465 Pftez Road oomm area ice. Phaw 10 A
City ... - -. Zip " Tel.
State Lic.
City
& Classif..��
2
Lic. #�
Sq. Ft. No. No. Dw.
-
Size Stories -Units-
' Arch.; Engr.;.. ... .. _.
..Designer
New Add ❑ Alter ❑. Repair ❑ Demolition ❑
Address
Tel.
2q it. 40 mol 10 x 10 ftp
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,'arid my license is.in full force -and
s>
effect.
SIGNATURE DATE
OWNER -BUILDER- DECLARATION
r I�hereby affirm that I am exempt from the Contractor's: License Law for the following
Estimated Valuation - . 20t 90 0 .. .
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 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 3 -bf the Businee ss and Professions Codor that. he is exempt therefrom; and •lh'e basis
:-foa the Any Section 7031. 5 by 'any for
- -
Plan Chk. Dep. - - - -
alleged exemption. violation of applicant. r permit
' 'subjects the applicant to a'civil penalty of not more than five hundred dollars ($500). -
-
-- '
Plan. Chk. Bal.
91.32do
[1I, as owner of the property, or my employees with wages as their sole compensation, will
the -work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
,
Const.
Professions Code: The Contractor's License Law does not apply to.an owner of property who
-builds
s
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 norbuild or improve for the purpose of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
-Plumbing MAID
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.I.• 1_17 - -
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
-
Grading
. ❑ I am exempt under. Sec. �-B. 8 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 cerlificaWof
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
.. _
Policy No. Company
_0 Copy is filed with the city. ❑ Certified copy is hereby furnished. .
TOTAL 290.19
CERTIFICATE OF EXEMPTION FROM
REMARKS -
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.) - - -
I certify that in the performance of the work for which this permit is issued, I shall not
- t
employ any person in any manner so•as to become subject to the Workers' Compensation
Laws of California.
"-Date ' ' Owrier -
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
• ZONE: BY:
subject to the workers' Compensation provisions -of the Labor' Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
,. CONSTRUCTION LENDING AGENCY
Side Street Setback -from Center Line
hereby affirm that there is a construction lending agency for the performance of the .
work for which this permit is issued. (Sec. 3097, Civil Code.) , ..
Side Setback from, Property Line ,
Lender's Name
Lender's .Address
FINAL.DAT.E. INSPECTOR
This is a building permit'when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that -the above information is *correct.
�'"�TiTy
Issued by: Date �7 cTyPermit
agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives,�of this city„to'`enter the above- .
mentioned property for inspection purposes'' r^
Validated by:
Signature of applicant'd -' r -`r%' !. • -s-%� Date' • 'y”
Mailing Addressi
Validation:
City, State, Zip I
_
6 Z 7. X9.0 1 9 Ck
A 5$ L
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I 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
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.
SO. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.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 ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
A
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
TANK
ffROCK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
RAGE
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL