AR (09305)53560 Avenida Martinez
09305
Building {' 78-105 CALLE ESTADO
Address V LA'QUINTA; CALIFORNIA 92253
Owneerg , d $..
Mailing BUILDING: -TYPE CONST. OCC:.GRP.
M Address .53-560 Martinez A.P. Number
City Zip Tel. ,
La iUuinta 92253 564-6392'' Legal Description " r
Contractor Project Description Room Ai diA:ifin
Owner/Builder
Address.
" City t Zip Tel.:
State Lic.
& Classif.
Lic. # i
Sq. Ft. : No.' " No. Dw.
-
-
Size 20 •.Stories •- -• Units
Arch:,' Engr., ` r
• Designer -. '-
New ❑ Add ❑ Alter ❑ Repair. ❑ Demolition ❑ .
Address
Tel. - —
.r
City
Zip •
State
Lic. #
r
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section -
7000,0
'- f Division 3 of the Business Professions Code,
and and -my license is in full force and'
effect.
_SIGNATURE DATE
.y r OWNER -BUILDER DECLARATION
'
Estimated Valuation
•.I hereby affirm that I am exempt from the Contractor's License Law for the following
.,zreason: (Sec. 703.1.5, Business and Professions Code: Any city or county which requires a a•
permit to construct, alter, 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 .:
,the
-PERMIT AMOUNT -
'.
provistons,of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
"i.'Divfsion 3 the Business Pro/essions he
•:r
0/ and Code, or that. !s exempt therefrom, and the basis
,for alleged exemption. Any violation o/'Section 7031.5 Dy. 'any applicant./or
- _ -
Plan Chk. Dep.
-the a permit
:subjects the appl c t to a civil penalty o/not more than live hundred dollars (3500).
N} I
Plan Chk, Bal, i S
as owner of the property, or my employees with wages as their sole compensation,.will ,
• the work, and the structure is not intended or offered for sale. (Sec. 7044, Bufsness
.
and
Pro/essions Code:. The. Contractor's license Law does not apply to an owner o/ who
Const:,,..
property
• builds or improves thereon and'who does such, work himself or throughhis own employees,
provfdad.that such improvements are not intended or offered for sale. If, however,• the building
-- • ^' - "
or
or Improvement is sold within one year o/ completion, the owner -builder will have.the burden.
Electrical ,1•., 5
o/ proving that he did not build or improve for the purpose of sale.)
1 n
O 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 /or
S•M.1. ' A7,,
' such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
_
,•
Grading
O 1 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
s ft
- O. Copy is filed with the city. O Certified copy is hereby furnished. ,-+
-
TOTAL F. 1. 44
CERTIFICATE OF EXEMPTION FROM -
'REMARKS f^
WORKERS' COMPENSATION INSURANCE
(This section need not be, completed p the perm!( !s for one hundred dollars IS 100) valuation •
'
"
..
or less.) .. ..
I certify that in the performance of thg work for which this permit is issued, I shall riot
:f
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. ,r' j •
Date ..
f
r '
Owne ...
NOTICE TO APPLICANT: ' aRer makng`thfs Certf/icate Exemption
of you should become
subject to the Workers' mpensation provisions of the Labor Code, you must forthwith- •
comply with such provisions or this permit shall be deemed revoked. ..
.ZONE: BY:
-
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 -i
Lender's Name
Lender's Address
'This is a building permit when properly filled out, signed and validated, and is subject to
,FINAL DATE INSPECTOR
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.
Issuedby: Date%' • - Permit
I agree to comply with all city and county ordinances and state 'laws relating to building
-
I 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
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT. p'
WALL SO. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WAiER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
REMARKS:
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 APPJEQUIP.
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
/ / j jf
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL