003333 (RR)44
P.O. BOX 1504 NO. 003333
Building 78-105 CALLE ESTADO
Address 52-600 0MG01; LA QUINTA, CALIFORNIA 92253
Owner
RRXE HOLT BUILDING: TYPE CONST. OCC. GRP. -
Mailing
Address SAM A.P. Number 773-224-006
City ZipTel.
._
(&Qi� A 92255 564-1032 Legal Description
Contractor Project Description=Q33
CUSTM ROOPUZ CO
Address
78-550 DAY ROAD
City Zip Tela
XND10 922€ 2 34545751.
State Lia City
& Classif. 274972 C_39 Lic. # 12 Sq. Ft. No. No. Dw.
Arch., Engr. .. . _. -
Size Stories Units
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... t.. j •
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, 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 of the Business'and'Prolessions 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 .-Plan *Chk. Dep.,
subjects the applicant to a civil penalty of not more than fivehundred'dollars ($500). Plan Chk. 'Bal.
'
❑ I, 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. (Sec. 7044, Buisness and Const. ° r
Professions Code:. The Contractor's License Law does 'not apply to an owner of property, who 28.Q 5C
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 build or improve for the purpose of sale.)
❑ 1, 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 projects with contractor(s) licensed pursuant to the Contractor's License Law:) -
Grading -
❑ l am exempt under Seca B. & 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 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. O Certified copy, is.hereby furnished.
TOTAL 29.00
CERTIFICATE OF EXEMPTION FROM REMARKS OOS j, a.1 -°t fi- 3,_48 i_ (1�•• I! ••� t __ !12 .
WORKERS' COMPENSATION INSURANCE yL ! ti:1}q I. I L' R % i.. .€ Y.;_
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
certify that in the performance of the work for which thispermitis 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 " ZONE: �BY: '
subject to' the Workers' Compensation provisions of the Labor Code, you must 'forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. '
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 Line
Lender's Name
Lender's Address FINAL.RATE INSPECTOR
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. Issued by: - DateR�� AIF ''Permit
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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. p $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT.
SO. 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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
I WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROUGH WIRING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAS (ROUGH)
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
WATER HEATER
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
BOND BEAM
SO.FT.GAR ® 3/ac
HOUSE SEWER
$
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 APPJEOUIP.
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
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL_
LATHING
i
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL .
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL