SFD 003036r. ..�y
P.O. BOX 1504 NO'. 003036
Building 78.105 CALLE ESTADO
Address 77--z 5 =MNIT LA QUINTA, CALIFORNIA 92253
Mailing
• Address
City
. 14 QV' A
Contractor
Address
P.O. Wm 329
Zip
92253
S919,
5644-2228
BUILDING: TYPE CONST." OCC: GRP: -N6`3
A.P. Number ' 774-0333
Legal Description LOT 3 F3IX 181
Protect Description mm -t.
�. City
Zip
Tel.'
State Lic.
City
& Classlf. 397 -. 1€9
Lic, # �-�. � � —
Sq.'Ft. 1747
No. I No. Dw. �
Size
Stories Units�
Arch., Engr.; - . ..
' Designer
New ❑ Add ❑
Alter ❑. Repair 0', Demolition ❑
Address
Tel.
City
Zip
State
-
Llc. #
. _. LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter B (commencing with Section
7000, of Division 3 of the Business and Profs slons Code, and'my'license Is In full.force `
and
. effect... � , •. �.� �. . _
..
SIONATl1FE^/' s•T.9.u� �,t ^ ,r• �`" t'-. •- "C+ DATE
..
OWNER -BUILDER DECLARATION
Estimated Valuation
1 hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031._5,Buslness _and Professions Code:. Any city or .county which requires a
-- permit to construct, after, improve, demolish, or repair any structuie,. 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. B (commenting with Section 7000),of'
' Division 3 o/:the Business and Professions Code, or that.he Is exempt therefrom, end'the basis
for .the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a'. permit
...Plan Chk: Dep.
7. .9 t7.
' subjects the applicant to a clvll penahy of not more then live hundred dollars ($500).-
'Plan Chk. Bal.
'
1122, IS
0 I; as owner of the property, or my employees with wages as their sole compensation, will .
do the work, and the structure Is not Intended or offered for sale. (Sec. 7044, Bulsness and
Cof1St.
.
X512.. ff
Professions Code: The Contractor's License Law does not apply to an owner of property who
bullds. or Improves thereon and who does such work himself or through his own employees,
-however,
Meoh.
.
provided that suchAmprovements are .not Intended or offered for.sale.. It; -the building
- or Improvement Is sold within one year of completion, the owner -builder will have the burden
•
EIBCtrICai
Q (,� -
.:ofproving that he did not build or Improve for the purpose ofsale.) •
.
❑ 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
J S•M,I,
Wq
-such projects with a contractor(s) licensed pursuant to the Contractor's -License Law.) ' k
Grading
.
`�R '
O I.am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
20.00
Date owner. ->'/"
Infrastructure
3,358.94
25100
WORKERS' COMPENSATION DECLARATION
' I hereby affirm that) haves certificate of consent to self -Insure; or a certificate of
r�g G p�
Worker's Compensation Insurance, or a certified copy thereof: (Sec. 3800, Labor Code.)
2 5.06
Pollcy' No. Company
0 Copy, Is filed with the city. . ❑ Certified copy Is hereby furnished.
TOTAL
2,400.83 2*150.83
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE '
(This section need not be completed U the permit Is for one hundred dollars ($100) valuation
or less.) - -
I certify that In the performance of th8 work for which this permit Is•lssued, I shall not
employ any erson-In any manner so as to become subject to the Workers' Compensation
Laws of California.
Date "Owner '
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 orthls.permltshalibedeemed revoked.
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
$Ids Street Setback from Center Line'
Ihereby afflrrn that there Is a construction lending agency for the performance of'the
work for which this permit is Issued. (Sec. 3087, Civil Code.)
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL, DATE
INSPECTOR
This Is a bullding'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 state that the above Information Is correct.
' 'agree
Issued•by,
Date Permit
}Ito 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
Mailing Address
Validation:
City, State, ZIP
A 7 7 1 4
4 8 -i 5083 it
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SO. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
4OLAB GRADE (M Z�
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAS (ROUGH)
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
WATER HEATER
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
BOND BEAM
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GRADING
cu. yd.
$ —Plus—X$—=$—
GAS PIPING
PERMIT FEE
PERMIT FEE:d
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
U LUMB
G
UNDERGROUND
A.C. UNIT
COLL. AREA
4OLAB GRADE (M Z�
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
RMS �i3
SEWER OR
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
y
FINAL INSP.
tC'/%
�ZROFI NGJ'J I�Q 1
FF
07 c
6�� d L✓{���% ��"—1 I-6 �(1�
LL e C
��/t/' y� ry f "
���(jI� �lG
P- �1,5i Q
REMARKS:
VENTILATION
FIRE ZONE ROOFING✓'(��J/
FIREPLACEi�/!/
SPARK ARRESTOR
FIREWALL
, ..//GAR.
/
YLl�LATHING �_�G_ ?
MESHge
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL