001723 (RPL)T 0 0 4hf 4 �
-L50 P.O. BOX 1504 No, 001723
Building *% �'� 78-105 CALLE ESTADO
Address �LA QUINTA, CALIFORNIA 92253
Jock 'k'
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number 773' -26:1 -Ml
Legal Description lot 22
Project Description 27100 pool and. $1 x 611 spa
Mailing
Address qa fM
City
L$
Zip
92253
Tel.
Contractor
.Tim ttiIOR.--
Address
City
' )4
Zip
Tel.
(7I4) 2A2-7031
State Lic.
City
& Classif.
Lic. #
Sq. Ft.
No. No. Dw.
Size
Stories Units
Arch., Engr.,
Designer
New 4st' Add
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
-
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70 00) 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 Contractor's License Law for the following,
reason: (Sec. 7031.5,Business and Professions Code: Any city, or county which .requires -a
permit to construct, after, improve, demolish, or repair any structure, prior to its, issuance also
requires the applicant for such permit to fife a signed statement that he'is licensed pursuant to
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
for the alleged exemption. Any violation of Section 7031.5 by 'any 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 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,
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
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-
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.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Estimated Valuation
PERMIT
AMOUNT
plan Chk.J Dep.
p
Plan Chk. Bal,
�. a4- w�
p0j
Const..
50
Mech.
17..50
f
Electrical
12.00
Plumbing
�n
18.0 i
S.M.1.
- .91
Grading
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
Ihereby 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. 38Q0, Labor Code.)
Policy No. Company
O Copy is filed with the city.. O Certified copy is hereby furnished.
TOTAL
204.03
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(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 Ceitificate 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: ..
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 FINAL DATE INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it 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'
Mailing Address Validation:
City, State, Zip
A 2 6 5 4 9 20 21,4,83 Sl
HARD COPY
Y
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SO. FT. p
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SO. FT. ®
GAS (FINAL) 5'
TEMP. POLE
WALL SO. FT.
DRINKING FOUNTAIN
SQ. FT. ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
VENTILATION
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
MESH
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 R 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 /J
h
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) 117 0 If
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL) 5'
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.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL