BLCK (04595)54401 Madison St
04595
t
TA
• '
P.O. BOX 1504
Building LA QUINTA CAL CALIFORNIA 92253
Address"1 7 $1 i13riTE"titt?2a®
0+'°5 ..
Owner
i 794 §xl S^aC f s ,Q 'G`alif*Vnia, tnc.
BUILDING: TYPE'CONST;M480'Z'ry OCC. GRP.
•'-
Mailing
Address 0.• B03%% -,1000
r N
A.P. Number
Legal Description +47X'i: 01Y1 Of , "s i • 16 M—R'
'
City
La t91 1 ,`92253
T lE 3 a ` 'Q
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Project Description 'a.
Contractor'
d6cdle
375 Long 1711{
Address - •::;
' City w.:lZip
Tel.
'4
.
45, .1'j
c
r.•
State Lic. - r,
8 Classif. f ;:
City
Lic. # 2 •.
V
Sq. Ft. No. No. Dw. '
J
Size Stories • Units
Arch., Engr., , :_ ;
New ❑ Add O Alter ❑ Repair ❑ Demolition O
DesignerI1dWA. Abe aign. .Platin
Address ?
Tel.
City
Zip
State
.`, •'i
Lic. #
_
• ..;:',• LICENSED CONTRACTOR'S DECLARATION
I herebyy,affirm that I am licensed under provisions of;Chapter 9 (commencing with Section
7000) of Divisibm3
t •
'
of the Business and Professions Code, and my license is in full force and
effect. r r 1 Y
SIGNATURE .%' J -' 0 1 •' ` DATE
{OWP4ER•BUILDERDECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation $7_ i► yy 4 V yy
y7 J '
. reason: (Sec. 7031.5:Business,and Professions Code: Any city or county which requires a
permit to construct,; after, 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 thathe 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.
_ •y
subjects the applicant to a civil penafty of not more than five hundred dollars (8500).
Plan Chk. Bal. -
O I, as owner of the property, or my employees with wages as their sole compensation, will
' Const. r a.-..
-•'T -f'?
.• G .;
_ do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions. Code: The -Contractor's License
apply pro ert who
Law does nota I to an owner of property.
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
improvement is
Electrical - -
or sold. within one year of completion, the owner-buUder will have the burden
of. proving that he did not build or improve for the purpose of sale.)
Plumbing
• ❑ I, as owner of theproperty, am exclusively contracting with licensed contractors to con-
struct the project. (Sec.- -7.044, Business and Professions Code: The Contractor's License Law
_
S.M.I. :. i
.:• ;=Y;
'.- ? •-
does not apply to an owner, of property who builds or improves thereon, and who contracts for
such projects with a contracloi(s) licensed pursuant to the Contractor's License Law.)
.r{:, .: r.
111 am exempt under Sec. - B. & P.C. for this reason
-
Grading
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consegIfptoself-insure, or a certificate of
• Worker's Compensation Insurance, or a certified copy;thefeof. (Sec. 3800, Labor Code.)
, ,
Policy No. Company ? j
❑Certified co❑ Copy is filed with the -city.' ei-s hereby furnished.
TOTAL t
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CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
'. (This section need not be completed if the permit is for one hundred dollars (5100) valuation
-,te,JTiy •" 4,g £ •y ,• ,k`-r$••i•1:a; ti.x E'' •` $
•' 4 Y •
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
ZONE: BY: -
- NOTICE TO APPLICANT: q„alter .making this Certificate of Exemption you should become
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 r
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 r
Lender's', Address
This is a building permit when properly filled out, signed and validated, and is subject to •
FINAL DATE INSPECTOR
expiration it 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 -of this city,to enter the. above-
mentioned property for inspection purposes. ' ra
Validated by:.
Signature of applicant ' ; Date
< Mailing Address - -
Validation: t '
A55E111SOR S OFFICE HARD COPY FILE
”
City, State, Zip - '
WHITE FINANCE PINK APPLICANT GREEN ,BVILDINGA00911IIf100
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
ISI FL SO FT y S
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. at
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT. a
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT.
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT. ra
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. Q
=$
LUMBER GR.
FINAL INSP.
URINAL
SO. FT. 0
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE, Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTOWISH)
APPLIANCE DRYER
FIREPLACE
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 C IM. c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/4c
HOUSE SEWER
CERT. OCC.
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 8 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.IEOUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL