BLCK (002041)Building
Address
Owner
Mailing
Address
City
la
Contractor
....Address .
4
P.O. BOX 1504
ESTAD52-640 Avenida ��' �b 78-105 CALLS
LA QUINTA, CALIFORNIAORNIA 92253
P.O. 0= 11.93
Zip Tel. '
uLnta
92253 56-1193
No.. 002041
BUILDING: TYPE CONST•.' OCC: GRP.
A.P. Number i, J •. i '"G' 1.: e:;r�1
j
Legal, Description
Project Description
280. ft. or 6fcxt high . fes.
lZip
Tela
' City . .. .. ,..
State Lic.
City
&•Classif.
Lic. #
Sq. Ft.' '
No. No. Dw.
Size • .Pro
Stories ..-Units
Arch., Engr , . .. -
Designer
New'L❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
TeL
City
Zip
State
r
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 DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following.
. reason: (Sec. 7031.5,Business and Professions Code: Any .city or county which requires .a
permit. to construct, alter, improve, demolish, or repair any structure, prfor'to its issuance also
requires the applicant for 'such permit to rile a signed 'statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
' Division3 of the Business and Professions Coda, or that.he is exempt therefrom, and the basis..,
for the alleged exemption. Any violation of Section .7031.5 by eny. applicant for a -permit
subjects the applicant to a civil penalty of not more than five hundred dollars' ($500).` - .. . '•
' O 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
Professions Code: The Contractor's Ucense Law does not apply to an owner of 'property who _'
Estimated Valuation
_
�l,3�5J77 .
,3 SJ S.► -
- -
PERMIT'..
AMOUNT
,x
Plan Chk. Dep..
. .
•'
Plan Chk. Bal..
'
25.02
Const..
"nA
38.517
Mech.
builds or improves thereon and who does such work himself *or through his own employees,
provided that' such Improvements are not intended or offered for sale. If, however,. the building .- .
Electrical'
'
or. improvement is sold within one year of completion, the owner -builder will have the burden
. of proving that he did not build or improve for, the purpose of sale.) .,-
Plumbing
O I, as owner of the property, am exclusively contracting with.licensed contractors to con- '
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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)..
- O 1 am exempt under Sec. - . B. & P.C. for this reason
S•M.1.
Grading
Driveway Enc.
Date Owner } f % 'r-•+ r•. f,I ="r
Infrastructure
WORKERS' COMPENSATION DECLARATION
kehereby affirm'that'l have'a'certificate of consent to self -insure, or a certificate of
Worr's Compensation Insurance, ora certified copy thereof. (Sec. 3800. Labor Code.)
Policy No. * .Company -
O Copy is filed with the city. O.Certified copy is hereby furnished. -
TOTAL
rst i2
REMARKS -
CERTIFICATE OF EXEMPTION FROM
WO R KERS' COMPENSATION INSURANCE -
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less;)
I certify that in the performance of the work for which this permit is issued, I shall not
- employ -any person 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
-subject to the Workers'' Compensation provisions of the Labor Code, you 'must forthwith
comply with such provisions or this permit shall be deemed revoked. - -
ZONE: BY: '
MIfllritum Setback Distances: • . '
Front Setback from Center Line
Rear Setback from.Rear Prop. Line
CONSTRUCTION LENDING AGENCY
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 Street Setback from Center Line
Side Setback from'Property,Llne
Lender's Name
FINAL -DATE
Issued by: -
Validated. by-,
Validation:
A 4 1 9 3
INSPECTOR
'
Date 2010-815. Permit.
2 10 64,L2 CC
Lender's Address
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 read this application and state that the above information is correct.
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.
Signature of applicant V �� t -Date
Mailing Address' f
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
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
WATER 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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEOUIP.
LAUNDRY TRAY
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
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
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 APP.IEOUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
hj6ENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL