003135 (RPL)y P.O. BOX 1504 No, 003135
Building54-800 fi31rC OII 78-105 CALLE ESTADO
Address g LA QUINTA, CALIFORNIA 92253
Owner
Tom Lyle BUILDING: TYPE CONST: OCG. GRP._
Mailing
Address A.P. Number 774""29$',}€:3
City Zip Tel.
La- (%*fnrA WWI Legal Description
Contractor
Project Description .��►"3
FUher T100IF:
Address
•.•��� t!sltNlif+rt�t� .1 i srnfrc T2r4rr.'•
City Zip_ Tela 7—//G-3
Cathedral City 92234 944_45 4
State Lia City
& Classif. Lic. # Sq. Ft. No. No. Dw.
496260 C'33 Size Stories.. Units
Arch., Engr.;
Designer New 0*. Add ❑ Alter ❑ . Repair ❑ -Demolition ❑
Address Tel.
City Zip State
Lic. #
_ LICENSED CONTRACTOR'S DECLARATION -
hereby affirm that.l am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division.3 of thee Business -and Professions Code, and my license is in full force and -
effect. 17 r6 ?.: //i 'r — F'.4 e7
SIGNATURE DATE- - `
OWNER -BUILDER DECLARATION Estimated Valuation
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, after, improve, demolish, or repairany structure, prior to its issuance, also 1V - AMOUNT
requires the applicant for such permit to fife a signed statement that he is licensed pursuant to - -PERMIT -
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
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 Plan Chk. Dep. ��,•� .)�
subjects the applicant to a civil penalty of not'more than five hundred dollars ($500). - -•
❑ I, as owner of the property, or my employees with wages as their sole compensation', will Plan Chk.• Bal.
do the wotk, and the structure is not intended or offered.for sale. (Sec: 7044,. Buisness and CO11St
Professions Code: The Contractor's License Law does not apply to an owner of property who. . 0412;^
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 �I
struet 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.) s ,
Grading
❑ I am exempt under Sec. B. 8 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.
lCompany
;•.1 Sr c ,f
Copy. is.fied with the city. . QeCertified 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.) -
I certify that in the performance of thg 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.
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
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 r
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
HARD COPY
TOTAL �► rt .� a t.
REMARKS' v
.. XSS'y,c a (:4r+ { n r. �'e7 F\/. •tit'._ rkY . f1
I ft t ` 1 f.i.'tL
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: Dates t -t t- • ' Permit
Validated by
Validation:—
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SD. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO. 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
HEATING (ROUGH)
MECHANICAL FEES
FORMS
WATER SOFTENER
ROUGH WIRING
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
FOUND. REINF.
APPLIANCE DRYER
METER LOOP
GARBAGE DISPOSAL
HEATING (FINAL)
FURNACE UNIT WALL FLOOR SUSPENDED
REINF. STEEL
LAUNDRY TRAY
TEMP. POLE
AIR HANDLING UNIT CFM
KITCHEN SINK
GROUT
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
FINAL INSP.
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
LUMBER GR.
BOILER B.T.U.
SO. FT. ® c
BATH TUB
FINAL INSP.
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
FIRE ZONE ROOFING
FIREPLACE
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FET7
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 APP./EOUIP.
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
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6
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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