RR (10388)51680 Avenida Madero
10388
T4hf 4 4 aubt!
P.O. BOX 1504 ! L No. 10388
Building `' l 1 a _ 78.105 CALLS ESTADO
Address -' " ` 1' ' LA QUINTA, CALIFORNIA 82253
Owner e7
Malting BUILDING: TYPE CONST. OCC. GRP.
Address Sz1.'i
A.P. Number
City Zip Tel.
53
Legal Description
Contractor
res 0.;- j .rj
Project Description
..'00 ;_
Address
City lzi, Tel.
201 3rd .. ii;u
State Lic. City
& Classif. ("`;3 9 3 ; 2 0 0 ; Lic. # 3 1 Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSEDCONY.RACTOR'S DECLARATION
harshy affirm•.that I am Iioerlsed un er provisions of Chapter 9 (commencing with Section
7000) of Dlvit ion 3 of the Btt&was an Professions Code, and my license is in full force and
effect:
.
SIGNATURE -DATE
awkER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation re
reason: tSec. 7031.5,13uslness and Professions Code: Any city or county which requires a i 8 2 `= ` • i
permll to aonstrucl, alter, Improve, demolish, or repair any seuclute, prior to its issuance also
requires the applicanf for such permit to fila a signed statement that he is. licensed pursuant to PERMIT AMOUNT
the provisions of the Contractor's license Law, Chapter S (commencing with Seclka 7000) of
Dvision 3 of rhe Business and Professions Code, or that he Is exempt therefrom, and the basis
for the alleged exemptton. Any obiauon of Section 7031.5 by any applicant for a parmH Plan Chk. Dep.
subjects fha applicani to a civ$ penalty of not mora than five hundred do$ars ($500).
❑ t, as owner of the property, or my empioyees with wages as their sole compensation, win Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, But5ness and Const.
Coda: The Contractors License Law dues not apply to an owner of properly who
builds or khproves theraen and who does such work himsell at through his own employees. Mech.
provided that such Improvements are not Intended or offered for sale. If, however, rho b uluft
or Improvement is surd wilhln one year of completion, the owner-buiWL-r wla have the burden Electrical
of pioving 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 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 contractors) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. & P -C. for this reason
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
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 _
i} Copy is filed with the city. ❑ Cerllfied 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 any person in any manner so as to become subject to the Workers' Compensation
Laws of
Cal 1Forn,a.
Date Owner
NOTICE TO APPLICANT: If, &nor 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 certify that I have read this application and slate that the above information is cafrevL Issued by: Date Permit
I agree to comply witty all city and county ordinances and state laws relating to building
constructlon, and hereby authorize representatives -of this city to enter the above-
mentioned properly for inspection purposes. Validated by:
Signature of applicant— Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION 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. 0
ESTIMATED CONSTRUCTION VALUATION E
UNITS
MOBILEHOME SVC.
POWER OUTLET
I
SLAB GRADE
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROCK STORAGE
FLOOR DRAIN
MECHANICAL FEES
METER LOOP
WATER SOFTENER
VENT SYSTEM FAN EVAP_COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
WATER HEATER
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
REMARKS:
SQ. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
HOUSE SEWER
FIREPLACE
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.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./EQUIP.
REIN F. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
; plus xa
=$
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