003883 (BLCK)Cl/
i
4614
P.O. BOX 1504 No. 0038$3
Building 78-105 CALLE ESTADO
Address 54"285 Carranza LA QUINTA, CALIFORNIA 92253
Owner
Linda C. Morla'cci BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address 'P. PiM7 1311-1 A.P. Number 774-242-013
City Zip Tel.
La- Quinta 92253 Legal Description
' ContractorProject Description 31 -`high i1lock ia12 161 long
j t 4er/Bu.? der
i Address
City Zip Tel.
State Lic. City
I & Classif. Lic. # Sq. Ft. No. No. Dw.
Size • Stories Units
-Arch;, Engr.,
i Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
L-ic. #
LICENSED CONTRACTOR'S DECLARATION 1
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.
i SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation y
I I hereby affirm that I am exempt from the Contractors License Law for the following $3 o.4 V p//1�A V
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
j permit to construct, after, improve, demolish, or repair any structure, prior to its Issuance also
requires the applicant./or 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 Division 3 of 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.
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
0 I, as.owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and �^ 9A
Professions Code: The Contractor's License Law does not apply to an owner of property who Const. V
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. ff, however, the building
or Improvement is sold within one year of completion, the owner -builder will have the. burden Electrical
i 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
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.l. Z: .rj(�.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)-
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
i Driveway Enc.
Date Prf Owner ` ' ' ��' r a " �� r Infrastructure
' I
WORKERSCOMPENSATION 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
` O Copy.is filed with the city. O. Certified copy is hereby furnished.
_ TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' -COMPENSATION INSURANCE
(This section need not be completed if the pemtit is for one hundred dollars ($100) valuation _ «_. _ r. -s_ _ nr•�
or less.)
I certify that in the performance of thg work for which this'permit is issued, 1 shall not
employ -any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
I Date - -' Owner
NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should become ZONE: - BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
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
Lenders Address FINAL DATE INSPECTOR
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. j
I certify that I have read this application and state that the above information is correct. Issued, by: Date 4J 211flaPefmit
I agree to.comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -ofthis city. to enter -the above-
mentioned
bove mentioned property for inspection purposes. Validated by:
Signature of applicant Date
Mailing Address - _ Validation: '
City, State, Zip
HARD COPY
T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. 0
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT. p
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN
SO. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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.
SO. FT. ® c
BATH TUB
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/ac
HOUSE SEWER
FINISH GRADING
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 APPJEOUIP.
REINF. STEEL4-714SAIA
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
e`/CBOND BEAM < J- y �/
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 SIGNATURES/INITIALS.
GARDEN WALL FINAL