001589 (RC)(� 11111111 IIIII III I I IIII 18
IE
Building 80--367 Avg. !a5
Address
Owner
Mailing
Address p.Qe BCX1000
City Zip
Contractor
Address
State Lic.
& Classif...
Arch., Engr.,-
Designer
Address
• �W
P.O. BOX 1504 No. 001589
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Tel.
5-2988
City
Lic. #
Tel.
City Zip State
.. . Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of'Chapter 9 (commencing with'Seclion
7000) of Division 3 of,the Business and Professions Code, and my license is in full force and
Meffect.
� r..>� -r�.. Air f -' ..e_ _ ,...r{..-•.` F . /.•_ 7i.
I SIGNATURE - DATE
OWNER -BUILDER DECLARATION
-.I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or 'county which requires a
BUILDING: TYPE CONST. OCC. GRP.-
A.P. Number
Legal Description
Project Description
Sq. Ft. No.
Size Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑' Repair a Demolition ❑
P -A .,iii vial.d i -ft_ Off
ima-
lEstiTated Valuation
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires theapplicant 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
Any Section 7031.5 any for
.plan Chk. De p -.
for the alleged exemption. violation of by applicant a permit
' 'subjects'the applicant to a civil penalty of not more than five hundred dollars ($500). • "
Plan Chk. Bal.
'
01 as owner of the 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.
$16 t-�
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
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
S.M.I.
-7A
-such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)•
Grading
-
❑ I am.exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
tri
. i on _ nft
WORKERS' COMPENSATION DECLARATION
N
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
❑.Copy is filed with the city. O.Certified copy is hereby furnished.
TOTAL
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 anyperson 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
' 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:
ae
Dat6n!7.7a A5 Permit . .
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 'Y �" - Date
Mailing Address ,t r
Validation:
City, State, Zip
AA
25_.
..6 1'87,24 CK
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP.IEQUIP.
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
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
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
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
I N SU LATIONISO U N D
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL