07809 (SFD)Building 950 SEei
Address
Owner
P.O. BOX 1504 No. 07809
78-105 CALLE ESTADO
y Drive LA QUINTA, CALIFORNIA 92253
Y
Acada CinStmictii?>r1
'Mailing BUILDING: TYPE CONST. •• OCC: GRP.
Address 02 . R A.P. Number Acacia. Hms `
City, Zip Tel: ,
artan � a Legal Description Tract 23268 Pian A-3
Contractor L01114
Project Description
Address
City: _ Zip Tel:
State.Lic' City
tg Classif: ) a. ,, Lic. # Sq. Ft.
Size
Designer New ❑
Address Tel.
City •+ Zip State.
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and;ProfessiopseCode,and my license is in full force and
`effect'
SIGNATURE
1 ' OWNER -BUILDER DECLARATION
•r
:•i No.
Stories
Add ❑ Alter ❑
No. Dw.:•,r-
Units
Repair ❑ 'Demolition ❑
1.
1 hereby affirm that I am exempt from the Contractors License Law for the following
Estimated Valuation
reason: (Sec. 7031.5,Buslness and Professions Code: Any city or county which requires a
''S74,,631'
permit to -construct, alter, improve, demolish, or repair any structure, prior to, its issuance also
-
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
Plan Chk. Dep.
250.00
a permit
subjects•the applicant to a civil penalty of not more than rive hundred dollars ($500)..•
❑ I, the
Plan Chk. Bal:
..'
_ - `� _
as owner of property, or my employees with wages as their.sole compensation, will
do the work; and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.Professions
_
13 1-3
Code: ;The Contractor's License Law does not apply to an owner of property who
Jb
builds or Improves I thdreon and who -does such work himself orthrough his own employees.
Mech.
f -.
provided'ithat 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'lheproperty, 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 of propertywhobuilds or improves thereon, and who contracts for
S•M.I.
•• r
such projects. with a contractors) licensed pursuant to the Contractor's License Law.)
Grading '
❑ Lam exempt under Sec. B. 8 P.C. for this reason
- ,
Driveway Enc.
j
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
Phereby 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
1
Copy Is filed with the city. O Certified copy is hereby furnished.
'
,��' _
TOTAL
2 .6909 ;
CERTIFICATE OF EXEMPTION FROM
REMARKS.
'
WORKERS' COMPENSATION INSURANCE
- ^ ^ ^ O ° �r •'
(This section need not be completed -if the permit is for one hundred dollars ($100) valuation
�t s y,�f tiAY�
t t
'' 8� Ei TlA L 76p „y?�
or less.)
I 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: 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
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:
?
Front Setback from Center. Line
Rear Setback from Rear Prop. Line +
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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.)
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
-INSPECTOR-
expiration if work thereunder is suspended for 180 days.
51419 '
I certify that I have read this application and state that the above information is correct.
Issued by:
-' Date ermit
I agree to comply with all city and county ordinances and state laws relating to building
-
,construction,
c onstruction,and hereby authorize representatives of this city to enter the above-.
r
mentioned property for inspection purposes. ., s, x_: _� •
Validated by:
Signature of applicant Date
-
Mailing Address
Validation:
. City, State, Zip
i<
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5:71.
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CCNSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SQ, FT. ®
CAR P. SO. FT.
WALL SQ. 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
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
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, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
FRAMING aO O
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
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 1-6
Z—OoOUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. /y
T i
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.-AX� E
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING aO O
ROOFING
/ �
/jZZ
� 9oT�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL//.2 �V
LATHING
MESH
INSULATIONISOUND! j��p
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL