RPL (09261)�, C
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'r - P.O. BOX 1504- NO. �' 926
Building 78-105 CALLE ESTADO r
• Address ;�( •�� � ... LA QUINTA, CALIFORNIN92253 _ s • , '
Owner
`• •- �.1, - is�, � 1. .. •� - -
•
BUILDING: TYPE CONST..' '' OCC; GRP'
Mailing .. � , _.
Address 42--600 Cook Street -4200 A.P. Number -
CityZip Tel.
Z�taiS&3Yt • r 92260 568--2838 Legal Description --
Contractor -
4 .Project Description • -
Address 1?001, and lava.,
68-46S"Perez Road r
City Zip Tel.: -
. Cat... Citv 9-223 _ 3.29-268.3 _
State Lic.
City
& Classif.
' 2-
Lic. # 69-
Sq. Ft. No: No. Dw.
Size Stories -Units `
1-
Arch:, Engr., _-
- -
New ❑ Add ❑ `'" Alter ❑ Repair°❑ Demolition Os
' Designer
Address ;>
Tel.
z
CityJ
Zip
State
Lic. #
i• `LICENSED CONTRACTOR'S DECLARATION'
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•• 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.
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SIGNATURE - DATE
OWNER -BUILDER DECLARATION . • ;•
Estimated Valuation `,"3
I hereby affirm that I am exempt from the Contractor's License Law for the following
. reason:. (Sec. 7031.5,Business and, Professions. Code:. Any city or, county which requires a
"PERMIT
+permit to construct, alter,;, improve,. demolish, or repair any structure, prior to its issuance also
r requires the applicant for such permit to file a signed statement that he Is licensed pursuant'. to :.
,. 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
'._*.tor thealleged exemption. Any Section 7031.5 by any for
Plan Chk. Dep.
violation o/ applicant a•permit
rY -subjects the 'applicant to a civil penalty of not more *than five hundred dollars ($500)1 _ •.
,
Pian Chk. Bal.
a❑ I, as.owner of the property, or my employees with wages as theicsole compensation, will
-
Const: • to .Edi '
?do.,the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and .
Code: The
u -'Professions .Contractor's.License Law does-not*apply to -an ownerof property who
builds'or improves thereon and who does such•work himself.or through his own.employees,
that'. improvements
Mech. � � - - Aft
,..provided such are not intended. orroffered for sale. If, however, the building
-or improvement is sold within one year of completion, -the owner -builder will have the.burden I
Electrical id n
of proving that he did not build or Improve for the purpose of sale.) ..
Plumbing2 t)n.•
❑ 1, as owner of the property, am exclusively contract I ng,wl th. licensed contractors, to.con-
' struct the project. (Sec. 7044; Business and Professions Code:.The Contractor's License Law
S.M:I, `
- '
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s)-licensed pursuant to the Contractor's License Law.) •
_
Grading..
O I;am exempt under Sec. B't;< P.C. for this reason
Driveway Enc. s
Date Owner'
Infrastructure
WORKERS' COMPENSATION DECLARATION
Thereby affirm that I have a'certificate of consent to self-insure,•ora certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.J _
c Policy No. -.Company--
CWopy is filed with the city. ❑'Certified copy is hereby furnished.
TOTAL- A.
4
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.) ,.., _ :.
sH' 'jggy 4 4?SgrYR 'btidli? 'ked "?A�1it1 3 , :•,
-
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 lo:become subject to the Workers' Compensation
-„ems, ,_s..,,•
Laws of California.
Date . Owner _
f
. NOTICE. TO APPLICANT:, If. after making this Certificate of Exemption you•.should. become
~• •
ZONE:• BY: '
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: ,- 'i', '
`Front Setback,from Center Line
Rear Setback from Rear Prop. Line
• - _'CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
1 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
t -
FINAL DATE INSPECTOR -
Lender's Address -
Stirs is a building permit when properly filled out, signed and'valldated, and is subject to •. �.
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.
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.' _
Validated by:
Signature of applicant Date
-
', Wailing.Address
Valldatl0n:-
-.
City, State, Zip
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®'
POR. SO. FT. ®
GAR. SQ, FT, ®
CAR P. SO. FT.
WALL SQ. FT. ®
SO. 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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
INSP�I
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