PLBG (3712)P.O. BOX 1504 Na.. 003712
_ Building78-105 CALLE ESTADO
Address .78 -990 -Miles — Sp+ 2i -- . ,LA QUINTA, CALIFORNIA 92253
.Owner i ... ... .. ;
'Mailing..
`�`r axa tzs. Half' BUILDING: TYPE CONST. OCC: GRP:
Address' same,
A.P. Number Vista Chines Mobile Part
City Zip Tel. y
L. i into 1.92253 Legal Description
Contracor Pluyibin' '
.. _ t.Project Description _ pexmit. for trailer'
ager/Builder
Address
City Zip Tel...
State Lic.
City
& Classif..
Lic. #
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, J
-
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
Estimated VdlUatiOn
I hereby affirm that I am exempt from the Contractor's License law for the following
:..3' !� •• -
dLO^
O
• reason: (Sec. _7031.5,Business. and. Professions Code: Any'city or county which requires a
'perinit
a ! �r
to construct, alter, improve, demolish, or repair any structure, 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.,x•"
' Division 3 of-the'Busin'ess and'Professions. Code: or that.:he is exempt'therefiom; 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 We civil penalty o/ not more than'five hundred dollars ($500). ." ' • '
'� •
Plan Chk. Bal.
❑ I, as owner of _the property, or my employees with wages. as their; solecompensation, will
do the work, and the structure is not intended or offered for sale: (Secy• 7044, Buisness and-"•
Const.
Professions Code: The Contractor's License Law does'not apply to an owner o/ property who
builds or improves. thereon and who does such work himself or. through his own employees,
Mech..
'
. provided that such improvements are.not intended or offered for. sale. If; however„ the'building
'
or improvement is sold within one year of completion, the owner -builder will havethe burden
Electrical-
- o/ proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- • .
Plumbing '
- -$,28 .00 ,
•' 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.
-- .. .. -•
• rsuch projects with a contractor(s) licensed pursuant to the Contractor's License. Law.)
Grading
0 I am.exempt under-Sec.B;.&-P.C. for this reason
Driveway Enc.
,. Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION ..
Thereby' 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�-
_ O 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 (S100) valuation
• or less.). _
I certify that in the performance of thg work for which this'permit is issued, I shall not.
- ,
¢fti fWis sr 7 Yf
IT F'Cbf a s 9
- +employ any peon in -any manner so -as to become subject to the Workers' Compensation
Laws of Cali fornirsa. .
-- - — -- - - -
Date___" Owner
NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should become
ZONE:.
BY:
subject 'to 'the Workers' Compensalioli' provisions of the Labor Code,' youmustforthwith
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
This is a building permit when properly filled out, signed and validated, and:is subject to '
FINAL DATE
INSPECTOR
expiration if work thereunder is suspended for 180 days.'
_ :•. — . _y'
I certify that I have read this application and state that the above' information is correct'-
'county
ISSUed by:'
j
Date 77 Permit
agree to comply with all city andordinances 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
$.
.. HARD COPY
_
14
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. Pi BING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SQ. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT.
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
A►
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 APPJEOUIP.
LAUNDRYTRAY
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.
SQ. 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:
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
SETBACKROUND
PLUMBINf
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
N5vLL; VM'S biu NA I UKLWIN I I IALS,
GARDEN WALL FINAL