08955 (BLCK)C&t�t
Of
P.O. BOX 150408955 .$
Building 78-105 CALLE ESTADO
Address 54-1$0 Aftlerat LA QUINTA, CALIFORNIA 92253 ,
Owner'
• tT dei >~r�d - (
MailingBUILDING: TYPE CONST.': ' + .00C: GRP. '
Addres l• z
r A.P. Number
City 'zip. Tel. ;
Legal Description
Contra`cfor �.. r - • �.w7 . .
4..; Project Description 19' �'� �+�nt e..._, �``��lr
w fornfa T1s 3c " ••• p•,••—
Address - _ - rE= ttil . .a ease rsf.- A Iks eii% *.-MI
4I-91PnA-rAvm1U .+ISA .,
City Zip Tel ;f
? N
•4' K9J;'
State M.""` .���w
&Classif. 1 t —7 Llc.'# 5;:._ Sq Ft. t s No. F =No.Dw.
Size Stories Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ r Repair ❑ Demolition ❑ .
Address Tel.
City Zip State
Lic. # -
LICENSED CeONTRACTOR'SyECLARATION
I hereby affirm that I am licensed.under provisions'of Chapter 9 (commencing with Section
7000) of D!Vision 3 ooff hbf
e Bbsinesss4nd Profes/ssll'o/ns/Code
,,�;and my license is infull force and s
effect
--,AX'A1.'/ f ir{s , /!� 3/.'y: c+.
SIGNATURE, "f M .r1',J xt— rX4 �! I If > ✓`.0 DATEy ' '• _
OWNER -BUILDER DECLARATION I !Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following $14,200.00
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- AMOUNT
requires the applicant for such permit to file a signed statement. that he is licensed pursuant to - PERMIT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of '
Division 3 o/ 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 /or a permit Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than live hundred dollars ($500). Bal.
Plan Chk•
O 1, as owner of the property, or my employees with wages as their sole compensation, will i 9rt
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
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;fhrough his own employees, -• , '{ d
-
provided that such improvements are not intended or offered tor. sale. 1/, however, the building • Mech.
24 :!A
or Improvement is sold within one year o/ completion, the ownerbuilder will^,have the burden . • EleCtrlCal, x "t
of proving that he did not build or improve /or the purpose o/ sale.) p - Zln _ t1A
O 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
does not apply to an owner o/ propertywhobuilds or improves thereon, and who contracts for $.M.L. • - . •';w•;
such projects with a contractor(s) licensed pursuanttothe Contractor's License Law.) - - _
11 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. Company - -
O�Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL
r CERTIFICATE OF EXEMPTION FROM REMARKS'
WORKERS' COMPENSATION INSURANCE tis a s1 t rf ..
(This section need not be completed If the permit is for one hundred dollars ($100) valuation - + . T es .(5,�t�' O[lTfit-13—;�0149 ISA �d
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. ZONE: - BY:
subject to the Workers' Compensation provisions of the Labor Code, you must. forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Y ! Side Street Setback from Center Line
Ihereby affirm that there is a construction lending agency for the performance of the
work
for which this permit is issued. (Sec. 3097, Civil code.) Side Setback from Property, Line -
Lender's Name
Lender's Address FINAL DATE INSPECTOR
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 car Illy 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
..lie »• t..
..} ,✓.' .,. �,�. • '1 J a • - .r+J.. r + Lr t�LYI. t.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SO. 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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED,
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
SQ. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
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.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
INAL INSP'e—"�li !7
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 SIGNATURES/INITIALS
GARDEN WALL FINAL :d