RR (13803)51835 Avenida Madero
13803
Tily 4 4 "
P.O. BOX 1504 Nn- 13803
Building _i 3, -ri 35 Ark :: : .'rQ 78-105 CALLE ESTADO
Abdress LA QUINTA, CALIFORNIA 92253
Owner
Ralph 'lurrach
Mailing
BUILDING: TYPE CONST. OCC. GRP.
Address A.P. Number
City Zip Tel,
a W,t;X;Y ;3., 91a5n,31 Legal Description
CZ%N- +" 1P Roo Ling Project Description'=ror.,
Cit .cl;txs C -A
Zip
2G? Tel.
92 345--173-
State Lic. City
& Classif. C--301 61-5038 Lic. # y 7 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 licensod under provisions of Chapter 9 (commencing with Section
7ppp) of Dlvislon 3 of the Business and Prbfesmons Code, and my license is in full force and
act. r
SMINATURE _. RATE
OWNER -BUILDER DECLARATION e f
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation 3 0 J
; •
reason: (sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, atter, 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 penalty of not more than five hundred dollars ($500).
❑ 1, 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
of proving that he did not build or improve for the purpose of sale.)
❑ 1, 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. 1.
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
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.)
Poi icyNo.--Camp any
06oprs filed with the c1ty. fJ Ced1fied 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) valuationL
or less.)
I cortlfy 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' ComperisationJUL
S 1 n , ryn ■
Laws of Cali arnIa. U L } ,994
Date Owner j
NOTICE TO APPLICANT: If, alter m#fng Ihfs Ceriificafe of t:xemprian you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code,you must forthwith 1
comply with such provisions orrhrsPermit shaubedeemed revoked. Minimum Setback Distances: t I
Front Setback from Center Llnt----
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
Ihereby 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 appllcatlon and state that the above infonnatlon is correct. Issued by; Date Rermlt
I agree to comply with all City and county ordinances and slate laws relating to build.ing
construction, and hereby authorize representatives sof this city to enter the above-
mentioned property 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.
2ND FL.
FOR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. ® $
SQ. FT.
SQ. FT_ ®
SQ. FT. ®
SQ. FT. ®
SQ. FT. ®
SQ. FT. @
VALUATION $
UNITS
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
iMOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
ROUGH WIRING
DRAINAGE PIPING
ROCK STORAGE
DRINKING FOUNTAIN
GAS (ROUGH)
URINAL
HEATING (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
GAS (FINAL)
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
BOND BEAM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ plus x$
LAUNDRY TRAY
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
SPARK ARRESTOR
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./EQUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGHAiU RES!lN1T]ALS
GARDEN WALL FINAL