003569 (PLBG) K",
VIIIIIIIIIIIIIIIIIIIIII 10 ZlaG
IE J
-- P.O. BOX 1504 No 00 1569
Building 78-105 CALLE ESTADO
Address 49=452 Avila LA QUINTA,CALIFORNIA 92253
Owner -
BUILDING: TYPE CONST. OCC.GRP.
Mailing
Address
A.P. Number _
City Zip Tel.
La Qlai 1 Legal Description
Contractor -
. .. .. . .. . Project Description Sewer Hook—up
Eca:9no Sewer Service .,
Address
£8-415 Perry Road
City Zip
tf`A+-hr,*A if 346-77C)l
State Lic. City
&Classif. 484961 Lic.# 342 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[,,,am licensed under provisions of Chapter 9(commencing with Section
7000)of Divisiioon��3•L-of�the Business and Professions Code,and my license'is in full force,anndi
effect. i , `tetIli—
SIGNATURE 4A 0— DATE
1.OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt fEstimated Valuation
rom the Contractors License Law for following
��•��
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
requires the applicant forisuch permit to file a signed statement that be 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.7ie 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 work,and the structure is not intended or offered for sale.(Sec. 7044,Buisness and Const. `, . y `
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, McCfl.
sprovided that such..improvements are not intended or offered for sale. If, however, the building ..
orimprovement 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
does not apply to an owner of property who builds or improves thereon, and who contracts for M.I. - - -
such projects-with acontractor(s)licensed pursuant to the Contractor's License Law.)
Grading
❑.l am.exempt under Sec: B.&P.C.for this reason
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.)
Policy No. Company 4 ,
❑Copy is filed with the city. ❑Certified copy is hereby furnished,
_ TOTAL t. 1.tY a f t x9.00 I�
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
-or less.) -
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must-forthwith Minimum Setback Distances: -
comply with such provisions or this permit shall be deemed revoked. - '
Front Setback from Center.Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY. Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued.(Sec.3097,Civil Code.) - - Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR'
This is a building permit when properly filled out,signed and validated,and is subject to
expiration if work thereunder is suspended for 180 days. - I� .�$
I certify that I have read this application and state that the above information is correct. Issued by: Date f 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
HARD COPY
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1ST FL. S0.FT.® $ UNITS
2ND FL. SO.FT.
YARD SPKLR SYSTEM
POR. SO.FT.® MOBILEHOME SVC. BAR SINK
GAR. SO.FT.® POWER OUTLET ROOF DRAINS
CAR P. I S0.FT.
DRAINAGE PIPING
WALL S0.FT.
DRINKING FOUNTAIN
SO.FT.® URINAL
ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING
NOTE:Not to be used as property tax valuation FLOOR DRAIN
MECHANICAL FEES WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH)
APPLIANCE DRYER GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY
AIR HANDLING UNIT CFM 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
SO.FT.®c WATER HEATER
MAX.HEATER OUTPUT,B.T.U. SO.FT.RESID®11/4 c SEWAGE DISPOSAL
SO.FT.GAR®3/ac 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) STORAGE TANK
FORMS GSEWER OR SEPTIc/tp�� 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
LUMBER GR. FINAL INSP.
cu.yd.
FRAMING FINAL INSP. $ plus x$ _$
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