PLBG (003747)T4hf 4 Sep QUM&
P.O. BOX 1504 No. 003747
Building 78-105 CALLE ESTADO
Address 7 -1`3 =`:.=�1=J�� LA QUINTA, CALIFORNIA 92253
Owner
Mailing t is BUILDING: TYPE CONST. OCC. GRP.
Address P. 0. Bax
A.P. Number
CityZip Tel.
f,,,a ,_ jinta t1�253 64-11 5 Legal Description
Contractor - Project Description ��==� we, >'f,3, and nit
Plumbing
Address
P. 0. Box
Gita L►:ttu Zip ({2253 Tel.5��7
State Lic. City
& Classif. 36 i 14 Lic. #;A , { 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 licensed under provisions of Chapter 9 (commencing with section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE: D,, T F
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby afflrm that I am exempt from the Cgntractors License Law for the following
reason: (sec. 703 x.5,Buslress and Professions Code: Any Illy or county which requires a
Permft io construct, alter, improve, demolish, or repair any 5fructurv, 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 penally of not more than five hundred dollars (5500)-
0 I, 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.)
❑ 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,
such projects with a confracior(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec B. t: 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
❑ Copy is filed with the city. ❑ 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 (8100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
employ anypefson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Dafe—__�_—Owner
NOTICE TO APPLICANT. N, after makfng IMM Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compansallon 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 road this application and state that the above information is correct. Issued Ly: Date 3 "' 5/1751" 'Permit
f agree to comply with all city and County ordinances and state laws relaling to building
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
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL.
2ND FL.
FOR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. ® $
UNITS
ROUGH PLUMB.
SQ. FT.
YARD SPKLR SYSTEM
SQ. FT. ® MOBILEHOME SVC.
BAR SINK
SQ. FT. ® POWER OUTLET
ROOF DRAINS
SQ. FT. ®
DRAINAGE PIPING
SQ. FT.
DRINKING FOUNTAIN
SQ. FT. ®
URINAL
VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
TEMP. POLE
FLOOR DRAIN
MECHANICAL FEES
GROUT
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
=$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FRAMING
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
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
GAR. FIREWALL
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.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 SE TIC TA �!•� 7
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REIN F. 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 SIGNATURESIINITIALS
GARDEN WALL FINAL