10354 (BLCK)P.O. BOX 1504 No. 10354
Building ry 78-105 CALLE ESTADO .- �j
Address 54" 130 RIV ERIA : LA QUINTA, CALIFORNIA 92253
Owner G- `
DR. FRED GRANT
i4 Mailing BUILDING: TYPE CONST. OCC: GRP.;
Address. 34.-130 RIVIERA
A.P. Number
City Zip Tel.
LA QUINTA . ' 92253 Legal Description
Contractor Project Description 6' % 20'. BIDOCK WALL
DWEITTE.CONST.
Address
75-145 ST, CHARLES PL, STE. 4
CityTel.:
PALM DESERTZip 922.60 773-4764
State Lic. City
& Classif. 42.3012-- Lic. # Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition:❑
Address Tel.
City k Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter (commencing with Section
7000) of Division 3 of the Business and Professions Code,,and my license is in full force and
effect. '
c�... SIGNATURE - DATE .
•::..." OWNER -BUILDER DECLARATION
•fir'^, -` '..f hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation .00 -
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
r-; permit to construct, after, improve, demolish, or repair any structure, prior to its Issuance also _ -
- .i requires the applicant for such permit to file a signed statement that he is 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 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 live hundred dollars.($500). .. I . - k'
❑ I, as owner of the property, or.my employees with wages as their sole compensation, will "Plan Chk. 681.
do the work, and the structure is not intended oroffered.for sale. (Sec. 7044, Buisness and Const.' 6 25�'i� -
Professions Code: The Contractor's License Law does not apply loran owner of property who • ,
builds or Improves thereon and who does such work himself or through his own employees, Mech. S+' y
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
struct the project. (Sec. 7044, Business and Professions Code: •The Contractor's License Law n
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.) '
❑ I am exempt under Sec. B. ti P.C. for this reason Grading -
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.) t
Policy No. Company '
A _
O Copy is filed with the city. .❑ Certified copy is hereby furnished..
TOTAL $41.35
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE a2 S
(This section need not be completed if the permit is for one hundred dollars ($100) valuation .;(,•V a;.O'� -„ rt ;l.�� t Z •1Z. 't ..ZI
or less.)
I certify that in the performance of tho 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. - -
O
NOTICE TO APPLICANTrIf, after making this Certificate of Exemption you should become ZONE: BY:,
'subject' to the Workers' Compensation provisions or the Labor Code, you •must forthwith , - -
complywithsuchprovisionsorthispermitshallbedeemedrevoked. . - Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Llne l"
Ihereby affirm that there is a construction lending agency for the performance of the c
work for which this permit is issued. (Sec. 3097, Civil Code.) • - Side Setback from Property, Line i.
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. L
I certify that I have read this application and state that the above information is correct. Issued by: Date Permit
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. Validated by:
Signature of applicant_ Date "
Mailing Address Validation:
City, State, Zip
• a
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. Sp. FT.
WALL SQ. FT. ®
Sp 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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SO. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11144 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 314c
HOUSE SEWER
REMARKS:
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
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
OND BEAM / .��i/
v
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
FINAL INSPECTION -
CERT. OCC.,
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL