09251 (PLBG)I. '.
4'4
P.O. BOX 1504 N V.
Building- 78-105 CALLE ESTADO.- '' r
LA QUINTA, CALIFORNIA:0253 ... �_� � �
Addres53-585 C� rQOi ice1
Owner
Mailing
.Q - i?, rfr �' �Y BUILDING: TYPE CONST. OCC: GRP.
Address
City Zip Tel
Contractor
. Address
State Lic. - I City
& Classif. 262678 Lic. # 1852
Arch'., Engr.,
Designer
Address Tel.
City I Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am,licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of t Business and Professions Code, and my license is in full force and, -
effect.
_SIGNATURE !�'c DATE
OWNER -BUILDER DECLARATION
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 tot such permit to file a signed statement that he is licensed pursuant to
-,. 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
-' t`: Iorl the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
;'subjects -the applicant -to a civil penalty of not more than rive hundred dollars ($500).
O I, as: owner of the property, or my employees with wages as their sole compensation, will
' do the work, antl„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
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
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:)
01, 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
such'projects with a contractor(s) licensed pursuant to the Contractor's License Law.) '
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
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.)
Poli `eNr]ore a5 _ iii Company .�°iL� i�'�'i
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'.COMPENSATION INSURANCE
(This section need not be completed if thepermit 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
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
Thereby 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.
Signature of applicant Date
Mailing,Address
City, State, Zip
A.P. Number
09251.
Legal Description
Project Description
Sp
F-yer Husk 11b
Sq. Ft. No. No. Dw.
Size 'Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const. '
Mech.
Electrical
Plumbing 30.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL ;30.. 00 _
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 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®'
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
GAS (ROUGH)
DRINKING FOUNTAIN.
SQ. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WAIER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
CU. yd.
plus x$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
MESH
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
INSPECTOR'S SIGNATURESIINITIALS
SO.FT.GAR ® 3/ac
HOUSE SEWER
GARDEN WALL FINAL
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 tq-SEPTte—T* d4C
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
REMARKS:
/
l
31 Z1f
VENTILATION//
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL