09319 (PLBG)Building
Owner
Mailing
Address
aama
City Zip
_
Contractor
& Classif
P.O. BOX 1504 C� 'v .
78-105 CALLE ESTADO �, 1J
a LA QUINTA, CALIFORNIA 92253
l
Tel.:
Cita"
Lic. #
Designer
Address Tel.
09319
BUILDING: TYPE -CONST. OCC: GRP. -
A.P. Number
Legal Description
Project Description
Sq. Ft. No. No. Dw.
Size Stories Units
New'❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencIng- .with Section
t. of Division 3 of the Business and Professions Code, and•my license is in full force and
effec
SIGNATURE �.' •'•-•-cr'O" J a'� :�.a'-.r:, .:,w•,' r`4. DATE
t OWNER -BUILDER DECLARATION Est
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 whichrequires a
permit to construct alter, improve demolishor repair any structure prior to its issuance also.
imated Valuation _
: such permit to file a signed statement that he is licensed. pursuant to
requlies the applicant for
:. PERMIT
the provisions or the Contractor's License Law,- Chapter 9 (commencing with Section 7000) of
_
Plan Chk..Dep.
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
subjects the applicant to a civil penalty ;of not more than five hundred dollars ($500):
O I, as owner of the property,. or my employees with wages as their sole compensation, will,
Plan Chk. Bal.
Const.,
do the work; and the structure is not intended or offered for sale. (Seca 7044, Buisness and
Professions 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
Electrical '
'
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.I.
such projects with a contractor(s) licensed pursuant to the. Contractor's License Law.)
' O 1 am exempt under Sec. B. & P.C. for this reason
Grading
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.)
Policy No. Company
.❑ 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 the permit is for one hundred dollars ($100) valuation,
or less.)'
1 certify that in the performance of the 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: It, 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
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.
Signature of applicant Date
Mailing Address
City, State, Zip
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
�o�at
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
Issued by:
Validated by:
Validation:
INSPECTOR
Date Permit
S S':
.- - ,... ;. _ .1 � - ..�1. , • _. - e. •. � - .. ♦ ' _ '. it s • �. .r ,. ....
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. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. 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.COOL 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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
FENCE FINAL
SQ.FT.GAR ® 3Yac
HOUSE SEWER
GARDEN WALL FINAL ::1
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE LPL.CCK.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 APPJEQUIP.
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
l�/_� /a/
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REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL ::1