001922 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54--295 Avenida la=eg LA QUINTA, CALIFORNIA 92253
Owner
` Mailing
Address
_ �s�ra
City Zip Tel.
..... la Quinta .92M .56443554
Contractor
Address
BUILDING:. TYPE CONST. OCC: GRP.
A.P. Number . 774-241--014,'
Legal Description IX& 3
Project Description
y ....
Cit
Zip
Tel.'
State Lic.
City
& Classif.
Lic. #
Sq. Ft.;
Size. .1110 -lin.-
No. No. Dw.
ft.,Stories - Units
_Arch., Engr.;
Designer-
New 0. :- Add ❑ Alter ❑ Repair ❑ .• Demolition ❑
Address
Tel.
City
Zip
State
Lic. # .
LICENSED CONTRACTOR'S DECLARATION
�t
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
reason: .(Sec..7031.5,Business and Professions Code. Any city or county which. requires - a
- peimit to construct, after, improve, demolish, or repair anyrstructure, prior to its •issuance also
requires.the applicant for such permit to file a signed statement that, he is licensed•pursuant'ro.--
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 ,
.subjects the applicant to -a civil'penatty of not more than five hundred dollars ($500). • '
❑ 1, as owner of.the property,, or my employees with wages as their sole compensation, will
• do the work, and. the structure is not intendedoroffered for sale. (Sec. 7044, Buisness and '•.
Professions Code: The Contractor's License Law does not apply to an owner of property whot.f�ta
Estimated Valuation*'
E" �v�.' ;
1� ""
•-
vPERMIT' ...
•
,
- AMOUNT
Plan Chk.. Dep.
- - - -
Plan Chk.. Bat.
.. _ -
'- Const. •.
. • ` . e�• h^�
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 safe., 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.) -
' Electrical ' '
'
�•'' ��
Plumbing
_
❑ 1, as owner of the property, am exclusively contracting. with licensed contractors to -con-
-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, andwhocontracts 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 .r`c
S.M.I. - -
-
- •• '
Grading
'
Driveway Enc.
Date Owner ��. ..a ��7�
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. (Seca 3800, Labor'Code.)
Policy No. ICompany
❑ Copy is filed with,lhe city. ❑ Certified copy is hereby furnished.
TOTAL
32 *00
-• CERTIFICATE OF EXEMPTION FROM -
..WORKERS' COMPENSATION INSURANCE -. •• -
.REMARKS
- -
(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 the work for which this permit is issued, 1 shall not
employ -any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
t
-
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. ' •
ZONE:' . - BY:
Minirnurri Setback Distances: -
_
Front Setback from Center Line
Rear Setback.from Rear Prop. Line
-CONSTRUCTION LENDING AGENCY -
I hereby affirm that there is a construction lending agency for the periormance'of the' .
' work for which this permit is issued. (Sec. 30R7, Civil Code.)
Side Street Setback from Center. Line
Side Setback from Property,Llne
Lender's Name
FINAL DATE
Issued by
Validated by:
„
INSPECTOR`
-.-
-• Date 1"�"-' - Permit
. +`
.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. r
Signature of applicant` t' •.. .•PJ'.. Oate
Mailing Address 4 �" `'`` ° "� Com' `. _ ^" "'
Validation:
A�3474
_
12. 320.0..
City, State, Zip
" HARD COPY
».'
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
2ND FL. SQ. FT. @
POR. SQ. FT. @
GAR. SQ. FT. @
CARP. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
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.
SQ. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
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
%-/�OUND. REINF. �J
1 !
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
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
f FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL