003600 (SFD)Building > >
Address
Owner
T4hf
.r u
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
4� Ntd q d�l
No. 003600
.arra
Mailing
Address F. 4.
r a amr
Box
ar _
1371
BUILDING: TYPE CONST.0.1
a r 7
A.P. Number 774"441,"�'=^
Legal Description
Project Description Simla
0-, OCC. GRP.
Fami1v Miellina
City
La AtB
Zip
92253
Tel.
Contractor
Tack Clark Construction
Address
:1250 . Qin ✓
Plan. Chk. Bal.
City
Zip
Tel.
State Lic.
& Classif. 506667
Mech.
City
Lic. #
Sq. Ft. 15RD No.
Size -Stories
New ❑ Add ❑ Alter ❑
No. Dw.
Units
Repair ❑ Demolition ❑
Arch., Engr.,
Designer
Address
Plumbing
Tel.
S.M.I.
5 Aril
Grading
CityZip State
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
. l� l {!
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, 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
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 or not more than five hundred dollars ($500).
❑ 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 or sale.)
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 contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B.•& P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby 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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i1 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 or 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.
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.)
Lender's Name
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 Date
Mailing Address
City, State, Zip
HARDCOPY
ZONE: BY: --. - - - .
Minimum Setback Distancesit,_'_CASA
Front Setback.from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATEINSPECtTOR
Issued by: ,~ Date �,ij �� Permit
Validated by:
Validation:
3timated Valuation
$83r653
PERMIT
AMOUNT
Plan Chk. Dep..
:1250 . Qin ✓
Plan. Chk. Bal.
9 55 „ M
Const.
385.00 A -
Mech.
86.00 �.
Electrical
79,2(1 .-
Plumbing
iff5.inA
S.M.I.
5 Aril
Grading
2{} An
Driveway Enc.
20 .00 ,
Infrastructure
1,848.73
TOTAL
REMARKS
ZONE: BY: --. - - - .
Minimum Setback Distancesit,_'_CASA
Front Setback.from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATEINSPECtTOR
Issued by: ,~ Date �,ij �� Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
c
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEQUIP.
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
Wl,FRAMING 7- -��
`?/
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
�I ii ' l� / (, l / / G �- �i �/ �(�
(� 'l/ 1 a
va
11
C� UQ��'Z
n�e
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
SPARK ARRESTOR
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR ® 3/ac
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
gfJNSU T
`
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
,/;-�IVCSETBACK d
GROUND PLU N6 f�oo�
r10,
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADES..- _? , C,7C'-
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS -
WER 0�9E
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF._7 J-
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
GRADING
cu. yd.
$ plus x$
-$
LUMBER GR.
Wl,FRAMING 7- -��
`?/
FINAL INSP.
nn
i�oGROOFING
\\
�I ii ' l� / (, l / / G �- �i �/ �(�
(� 'l/ 1 a
va
11
C� UQ��'Z
n�e
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL�(y
LATHING
MESH
gfJNSU T
`
FINISH GRADING
�
NAL INSPECTIO `2
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS,
GARDEN WALL FINAL