SFD• r,
4 4 Q
P.O. BOX 1504
% 78-105 CALLE ESTADO APPLICATION ONLY
Building � `
Address >- G �� LA QUINTA, CALIFORNIA 92253
Owner
DOM l N (C R, 4 1' • • .
l ID
Mailing BUILDING: TYPE CONST. OCC. GRP.
Address ?/31 fi. L. L Rd. A.P. Number —77Y—a_5_51—Q7-7-
City
77Y--aSS—DZZCity ZipP1_1a8a
D �/i w5 �QZI��11_?)d Legal Description o % /. Z
ContractorD^ Project Description
Address / 1lTit1 ,[ W L L
7 f AW �
City3 Zip Tel
State Lic.City " i
& Classif. a00.�"€3 Lic. # ! -Z1 Sq. Ft. No. No. Dw.
Arch., Eng r., / Size �'�C. Stories, Units
Designer .S42 /Y 65r A,.S�7 '1PL,!o-De New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address "` Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 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
-
SIGNATURE'DATE ,
OWN ER-BU ILDER-DECLARATION- Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following A
reason: (Sec. 7031.5,Business and Profession;lcode: Any city or county which requires a
permit to construct, after, improve, demolish, orrepair any structure, prior to its Issuance also.
requires the applicant for such permit to file a slgned.statement that he is licensed pursuant to PERMIT - AMOUNT
the provision,./ 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. dy ✓(j, o D
subjects the applicant to a civa penalty of not more than five hundred dollars.(8500). Plan Chk. Bal.
❑ 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, Buisness and Const.-2.-73 a �a
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. "3 �b
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 —7-7,17
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 �d ,
struct the project. (Seca 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds of improves thereon, and who contracts for S.M.I. 7
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason Grading O • c7a,
Driveway Enc. 1 � Zd Dc7
r
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION r
I hereby affinn'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.T
TOTAL 7 S ^ ,On e
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit is for one hundred dollars (5100) valuation {�(jIj f { ? 1 (1 f .7iq, t;l�.j—).0-8� ,(�
or less.) 10 LASH 1 I M AL � Z VV
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any pperson 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 o/ Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the of,
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
Lenders 'Name
Lenders Address FINAL DATE INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
expirationif 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 agiee 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
.Mailing Address Validation:
City, State, Zip
BUILDING DIVISION
CONSTRUCTION ESTIMATE
GROUND PLUMBING
NO. ELECTRICAL FEES
NO.IUMBING FEES
1ST FL. SQ. FT. ® . D $
/
UNITS
BONDING
HEATING (ROUGH)
2N3 FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
FOUND. REINF.
MOBILEHOME SVC.
METER LOOP
BAR SINK
GAR. SQ. FT. ® W
REINF. STEEL
POWER OUTLET
TEMP. POLE
ROOF DRAINS
GROUT
WATER HEATER
SERVICE
DRAINAGE PIPING
CAR P. SQ. FT.
BOND BEAM
WATER SYSTEM
GRADING
Cu. yd.
$ -Plus-X$-=$
WALL SO. FT. ® e
a%
FINAL INSP.
DRINKING FOUNTAIN
SQ FT ®
ROOFING
URINAL
ESTIMATED CONSTRUCTION VALUATION $
U
VENTILATION
WATER PIPING
NOTE: Not to be used as properly tax valuation
FIRE ZONE ROOFING
FLOOR DRAIN
MECHANICAL FEES
FIREPLACE
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APP_IANCE DRYER
LATHING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FINISH GRADING
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
FINAL INSPECTION
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
CERT. OCC.
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
G
SHOWER
BOILER B.T.U.
GARDEN WALL FINAL
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 C
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
Z
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
/
PERMIT FEE
DBL
TOTAL FEES
MICROFE7 MECH.FEE
PL.CK.FEE
CONST. FEE
ELECT. FEE
SMI FEE PLUMB. FEE
?.y
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.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL