003820 (BLCK)P.O. BOX 1504 No. 003820
Building 78-105 CALLE ESTADO
Address 51-970 0bratuon. LA QUINTA, CALIFORNIA 92253
Owner
Sieve C-arza
Mailing � ' , I . BUILDING: TYPE CONST: OCC,. GRP..
:.
Address Aa me A...P. Numbe.r
TTt_yZip Tel.
Tan 0vii-Ty-t-a' 92291 564-1657 Legal Description
Contractor Project Description _50" winInd
-and -2 WCfqd, gate
Address
City' zip Tel:
State -Lic. City
& Classi.f.:. Lic. # Sq. Ft. No. No. Dw.
Size Stories. -Units
Designer New 0 Add 0 Alter 0 Repair 0 Demolition 0.
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
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation
reason: (Sec. 7031.5,Business and Professions Code:. Any, city or county which requires a
permit to construct, after, 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 Professions 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 penally of not more than five hundred dollars ($500).
0 1 as o net of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do ihe 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 Const. $20 00
builds or improves thereon and who does such work himself or through his own employees,
44 provided that' such improvements. are not intended or offered for sale. If, however, the building MeCh.
or. improvement is sold within one year of completion, �:the owner -builder will' have the burden Electrical -
of proving that he did not build or improve for the purpose of sale.)
0 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
struct the project. .(Sec. 7044, Business and. Professions Code: The Contractor's License Law
does not apply to an owner of properly who -builds or improves thereon, and who contracts for S.M.I.
-such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)Gradin
11 I.am.exempt under Sec.-. B. & P.C. for -this reason 1 9
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm' that I have a'certificate of consent to self -insure; or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No' ' Company
0 Copy is filed with the city. 0 Certified copy.is. hereby'furn !shed.
CERTIFICATE OF EXEMPTION FROM
WORKERS'. COMPENSATION INSURANCE
(This section need not be completed if the permit is for one -hundred dollars ($ 100) 'valuation
or less.)
I certify that in the performance of thp work for which. this permit is issued, F shall not
employ -any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date_0wher
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become
subject to the 'Workers' Compensation provisions, of the 'Labor Code, you mus( 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 Nam
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 -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant -Date
Mailing Address
City, State, Zip
HARD COPY
TOTAL
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 4 / 11/ $ Permit
Validated by
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
FOR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOB]LEHOME 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.000L 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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
r
04WENCE FINAL 6--`/'p Y
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL