001594 (BLCK)'4
P.O. BOX 1504 N O . 001594
Building 78-105 CALLE ESTADO "
Address 51-080 .bvw0aagagmLA QUINTA, CALIFORNIA 92253
Owner
gip" °l%uon Cbrst. BUILDING: TYPE CONST. OCC: GRP.
Mailing "
Address P.Q. ftx 2289 A.P. Number
City Zip Tel.
� 92201 U7-7171 Legal Description
Contractor Project Description
Address...
aboW
City .... Zip. Tel..
Ab f Win
State Lic. City
& Classif.. Lic. # Sq. Ft.No. No. Dw.
. .
Size Stories • Units
Arch., Engr.;
Designer New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State 150 Of aft hi� reinkn X0
Lic: #
211.
LICENSED CONTRACTOR'S DECLARATION
:4 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
' ^ 70pp) of Division 3.of theeBusiness and Professions'Cod`e, and my licenseisin full force and
M.4
SIGNATl1RE .+ DATE _ w
OWNER -BUILDER DECLARATION Estimate
Valuation
I hereby affirm that'I am exempt from the Contractor's License Law. for the following _�'
reason: (Sec. 7031.5,Business and Professions Coder -Any ,city or county. which requires 'a . .60
. .
pemitt'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 heir 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 Professioris'�'Code; or that. he is -exempt therefrom; and the basis .....•
for the alleged exemption. Any violation of Section 7031.5 by 'any :applicant for permit Plan Chk..Dep. -
subjects the applicant to a civil penalty of not more than five hundred dollars (S500). --
❑ 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 CO.rISt: �
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 or 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
struet the project. (Sec. 7044; -Business and Professions Coder The Contractor's License -Law
does not apply to an owner of property who builds or improves thereon; and who contracts for$,M'.I. - .50 -such projects -with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under. Sec..B. 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 furnished.
TOTAL 39.00
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'- COMPENSATION INSURANCE
(.This section need not be completed if the permit is for one hundred dollars ($100) • valuation -
or less.) .. .. ..
1 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 torbecome 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 ffom.Center Line -
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
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
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: Date
agree* to comply with all city and county ordinances and state laws relating to. building
construction, and hereby authorize representatives of this city.Ao enter the above-.
mentioned property for inspection purposes. !, Validated by:
.. .err..... .;i ,�3r C{'_••,: y .
Signature'of applicant .' 'k, r Cafe
Mailing Address Validation:
City, State, Zip
A1761, .6.. 2.7 39,00 CK
HARD COPY
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR GOND. SOLAR
SETBACK
GROUND PLUMBING
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
ROUGH PLUMB.
2ND FL. SQ. FT. Q
HEATING (ROUGH)
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DRAINAGE PIPING
WALL SQ. FT. ®
HEATING (FINAL)
DRINKING FOUNTAIN
SQ FT ®
5
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
cu. yd.
$ -Plus-X$-=$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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.
SQ. FT. ® c
BATH TUB
FIRE ZONE ROOFING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 C
ISEWAGE DISPOSAL
SPARK ARRESTOR
SQ.FT.GAR ® 3/4c
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 GOND. 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./EQUIP.
T, REINF. STEEL
5
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
a AL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL