001918 (TT)P.O. BOX 1504 No. 001918
Building78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
arks i a k land oD.
Mailing
BUILDING: - TYPE CONST. OCC: GRP.
Address P.O. 19.E A.P. Number
City Zip Tel.
La 922-W1 .345-2658- Legal Description
Contractor Project Description 1 1 OYE 1"V TIMiler ftr
G01&M Offlim Tgmil=s Pilot Pm -Classing to be Mbd at
Address .
P.O. BM 668
La Cill4Mta Tamit lub
City Zip Tela "
Wild 92335 (710-674-5655
State Lic. City
& Classif. Lic. # Sq. Ft.rr 2o� No. No. Dw.
Size' Stories Units
Arch.; Engr., -'
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
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, and -my license is in full force and
effect..
SIGNATURE DATE ... .
OWNER -BUILDER DECLARATION" Estimated Valuation
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 to construct, atter, 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, Chapter9: (commencing with Section 7000) of
'Division 3 of the 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 ' Plan Chk., Dep. -
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). -
O I, as.owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for. sale. (Sec. 7044, Buisness and ConSt.i.f��
.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 builo or improve for the purpose of sale.)
O 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.I. -'
such protects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O I am exempt under Sec. B. 8 P.C. for this reason - Grading
Driveway Enc.
Date Owns V % l • 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' 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 tha 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 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 it 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 applicant '+� r % �' Date j
Mailing Address
City, State, Zip
HARD COPY
TOTAL2,Q4.
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
FINAL DATE INSPECTOR
Issued by:. Date Permit
Validated by:
Validation:
A3443 12 2 21200 R
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU PEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SD. FT.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
DRINKING FOUNTAIN
SQ. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ -plus-x$_=$
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FIREPLACE
SQ.FT.GAR ® 3/4c
HOUSE SEWER
SPARK ARRESTOR
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 APPJEQUIP.
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
WAL INSPECTION
`CERT.
OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WkL fJht&L'„ _,