12975
79700 Arnold Palmer
IIIIIIIIIIIIIIIIIIIIIIIII 15 TRY 4
P.O. BOX 1504 No. 12975
Building —1q --7,-,H') A,=nr.)ic: P; Lmer 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Mailing BUILDING: TYPE CONST. OCC. GRP.
Address Z si u : n R.P. Number
City Zip Tel.
_, u rta, i 972)5i 364-4463 Legal Description
Contractor Project Description 3.t?C'tYi.^ pedc sta
3 '_, ,
Address 7i7't''r ? d Pa]_ .lt:: C.ourze.
City Zip Tel.
State Lic. City j .1
& Classif. Lic. # 3 Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel -
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed trader provisions of Chapter 9 (commencing with section
7004) of Division 3 of the Business and Professions Code, and my license is in full force and
-effect.
SIGtlwTunE ❑ATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Buslnass 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
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 penally 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 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 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 ry
of proving that he did not build or improve for the purpose of sale.) '
❑ I, as owner of the property, am exclusively cOntfaoting with licensed contractors to con- Plumbing
struct the project. (Sec. 7044, Business and Professions Cade: 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 confractor(s) licensed pursuant to the Contractor's License Law.) - -
11I am exempt under Sec. B. t> P.C. for this reason Grading
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
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,)
Paflcy No company
E* Cgpy s; filed.wlth the city. L Certified copy is hereby furnished.
TOTAL 3
CERTIFICATE OF EXEMPTION FROM REMARKS
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 the work for which this permit is issued, I shall not
employ any person in any manner so as to become suh]eCt to the Workers' Compensation
Laws of Galifornla,
Date Owner
NOTICE TO APPLICANT: If, after muA'ing this Certificate of Exempgcan you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions W 1INS pePnil shall be de em ed re vuk ed'. 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 perrhill 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- 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 sof this city to enter the above.
mentioned property far inspection purposes- Validated by:
Signature of applicant -Date-
Mailing
,DatsMailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
I
IST FL
2ND FL.
POR.
GAR
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ $
SQ. FT.
SQ. FT. r@
SQ. FT. @
SO. FT.
SD. FT. @
SQ. FT_ @
VALUATION $
COLL. AREA
UNITS
ROUGH PLUMB.
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS f}
SEWER OR SEPTIC TANK
DRAINAGE PIPING
DUCT WORK
DRINKING FOUNTAIN
FOUND. REINF.
URINAL
GAS (ROUGH)
WATER PIPING
NOTE: Not to be used as property tax valuation
OTHER APP.IEOUIP.
FLOOR DRAIN
MECHANICAL FEES
GAS (FINAL)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER HEATER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
WATER SYSTEM
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
cu. yd.
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 1+/4 c
SEWAGE DISPOSAL
$ -Plus-X$-=$
SQ.FT.GAR ® 3/sc
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
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGETANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
LUMBER GR.
FINAL INSA. f
cu. yd.
FRAMING
FINAL INSP.
$ -Plus-X$-=$
REMARKS:
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
1NSPECTDR'S -SI GNATU RESII N kTIALS
GARDEN WALL FINAL