002504 (RPL)Building
Address
80"7.5
Owner
New Q Add --0
Mailing
Address
Address
75-0115 c5camC12
City
Zip
1l�pk3rm
Y1 c x . ..
g726r,
Contractor
.
100 am Pw1 +_141'
Address .
City
LICENSED CONTRACTOR'S DECLARATION
Zip
State Lic.
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7000) of Divisiion3 of the Business and Professions Code, and my license is„in full force, and
effect..
& Classif.
APIVI
Tel.
Tela
City
Lic. #
P.O. BOX 1504 NO., ��Q
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
!77: Legal Description
Project Description IM MT PW= 11 A
Sq. Ft. No. No. Dw.
S'ISt
ze •-
Arch., Engr.,
Designer
or es -Units
New Q Add --0
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
100 am Pw1 +_141'
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7000) of Divisiion3 of the Business and Professions Code, and my license is„in full force, and
effect..
'
SIGNATURE VVn-4 4 ”' DATE
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
EStlmated VallJatlon
'
PERMIT
- �' 'AMOUNT
to construct, after, improve, demolish, or rep air -any"•structure. prior to its issuance also
requires the applicant for such permit to rile a signed statement that he -is licensed pursuant. to
the provisions of the Contractor's License Law, Chapter9 (commencing with Section 7000) of
' Division 3 of the Business and Professions Code, of 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 of not more five hundred dollars ($500). -
0 I, as owner of the property, or my employees with wages as their sole compensation, will'
.Plan�Chk. Dep.
_
- -
Plan Chk. Bal.
COnSt.
'
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
-.
Mech.
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
orimprovement 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.) .
Electrical
Plumbing
❑ 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
S•M.I.
'
• such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - -
.❑ I am exempt under .Sec. B. & P.C. for this reason
Grading
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that'I hale 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.
TOTAL
�i
66.55'0
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
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 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.
..
Date Owner
NOTICE TO APPLICANT., ft, after making this Certificate or Exemption you should become
subject 'to 'the Workers' Compensation provisions or the -Labor Code, you must forthwith '
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY:
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. 3097, Civil Code.)
Side Setback from Property.Llne
Lender's Name
FINAL DATE
Issued by:
Validated by:
Validation:
A 6 0 6 7
INSPECTOR
2Ly
Date ' 9-8 Permit
% 29 2250 U
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 tocomply 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 inspejction purposes.
Signature of applicant
Mailing Address
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
2ND FL. SQ. FT. @
POR. SQ. FT. @
GAR. SQ. 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
EONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. RESID @ 11/4 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.
EONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
FOUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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