002462 (BLCK)f P.O. BOX 1504 No. .00246 2
Building 57"ya ��. 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Be,= val1w Finmw
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address^f
si: 13M A.P. Number e '%
P.O. H `
City Zip Tel.
�a� (714+3453 Legal Description
Contractor Project Description
Address
3A020 Mtn Palm Ltri
'City
Zip Tela
Camel t�.� 9-22403 32.-10n
State Lic. City
& Classif.., Lic. # Sq. Ft, No. No. Dw.
Size Stories Units
Arch., Engr.,
Designer New ❑. Add ❑ Alter ❑ Repair O Demolition ❑
Address Tel.
City Zip State 75 _n-. fta of 4—frx* �'nty
Lic. # . .
LICENSED CONTRACTOR'S D€CLARATION 11c4mW hicfh rC._+A4_niy
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section V
70 130) of Division 3 of the Business and Professions Code,'and my license is in full force and
.effect.
SIGNATURE ri DATE _
OWNERwBUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the'following:
reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a 1.674.00
...reason:
to construct, after, improve, demolish, or repair any structure, prior to its: issuance also '
-requires. the applicant for such permit to rile a signed statement that heis-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 allegedexemption. Any violation of Section 7031.5 by 'any applicant..fora permit Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). • . ' q®
❑ I, as owner of. the property, or my employees with wages as their sole compensation, will' Plan Chk. Bal. 18.20
do the work, and the structure is notintended or offered for sale. (Sec. 7044, Buisness and Const. d. .i
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds- or improves thereon and who does such work himself or through his own employees, Mech.
..
provided that such improvements are- not intended or offered for sale. If, however, the building,
or improvement is sold within one year of completion, the, owner -builder will have the burden Electrical
of proving that he did not build or improve for the purpose of sale.) -
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
slruct the project- (Sec. 7044, Business and Professions -Code: The Contractor's. License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for S. M;
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exemptunderSec. B. & P.C. for this reason
Driveway Enc.
Date owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate' of consent- to'self- insure, or a'certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. .Company
❑ Copy is filed with the city. 0 Certified copy is hereby.furn!shed.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($ 100) valuation
or less.) -'
I certify that in the performance of 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: If, after making this Certificate of Exemption you' should become
subjectto 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 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.
I
Signature of applicant —Date—
Mailing
ateMailing Address +
City, State, Zip
HARD COPY
TOTAL 46.70
Q
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 7-16—SGPermit
Validated by:
Validation:
A5970 7 16 4671; CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINry FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. 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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
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, TEM/PERM
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.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
OND BEAM l,/ 2�
�/
SQ.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
41fO REINF. 71f -11w
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
/
EINF. STEEL r
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
OND BEAM l,/ 2�
�/
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
'_ DEC
1 7
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
I brrt.1 On "J WU nA I Un tblIN 111ALb.
GARDEN WALL FINAL
7-7Vr6 Joy.
ry rl