002057 (PAT)P.O. BOX 1504 No. 002057
Building 78-105 CALLE ESTADO
Address 51-970 Avmaida Chiriamn LA QUINTA, CALIFORNIA 92253 -
Owner
roman Gmma BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address Sam A.P. Number
City Zip Tel.
FIMi�Ant- < ra � �D� .. Legal Description
Contractor Project Description
Address- .
City Zir) Tela -
State Lic.
City
Minimum Setback Distances:
& Classif.
LIC. #
Sq. Ft.
No. No. Dw.
Side Street Setback from Center Line '
Size .. ..
•
Stories. Units
Arch., Engr.,...
Designer
New ElAdd ❑
Alter ElRepair El.Demolition ❑
Address
Tel.
Validation:
A 4 3 2 6
City
State
JZip
Lic. # ..
LICENSED CONTRACTOR'S DECLARATION
hereby affirm that I am licensed under provisions of Chapter 9 (commencing with'Seclion '
7000) of Division 3 of the Business and Professions Code, and'my license is in full force and
effect.. .
-
SIGNATURE DATE
OWNER -BUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Law for the following .
reason: (Sec. 7031.5,Buslness and Professions Code: Any".city or county which requires a
permit.lo 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
Estimated ValUatlOn,
PERMIT-:
AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code; *orthat' : 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 penally of not more than five hundred "dollars ($500). "'
❑ I, as. owner of the property, or my employees with wages as their:sole compensation,. will..
-
Plan Chk. BBI. .
- '
Const
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
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. -
EIQCtrICdl
+��y
2 00
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.)
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.1-
`
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 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
Q Copy is filed with the city.. ❑ Certified copy is hereby furnished.. .
TOTAL
12 �gs 00 t�tt
REMARKS
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, Ishall 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
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 sof this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant—1 / Date
Mailing Address— _
City, State, Zip
HARD COPY
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 2"'20-86 Permit
Validated by:
Validation:
A 4 3 2 6
2 20 JZ00 it
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SO.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.
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.IEOUIP.
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
�-( (('INAL INSPECTION 2
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL