002032 (PC)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54-425 AMU& Q=M= LA QUINTA, CALIFORNIA 92253
Owner
C TmI
No.. 002032--
z
'
Mailing
Address P.O. � 228
_
BUILDING: TYPE CONST. OCC. GRP.,
A.P. Number 774-242-020
Legal Description SOC Zig
Project Description
City
Zip
42202
Tel.
Contractor
Address. .
.�
� R. ��3 i'�_cf Cll•Dtl'I�T
"City
Zip'
Tela
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
State Lic.
& Classif.
City
Lic. #
Sq. Ft. No. No. Dw.
Size Stories Units
Arch:; Engr:, '
Designer
New•Z Add ❑ Alter ❑ Repair ❑ Demolition ❑.
Address
Tel.
Plumbing -
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
City
Zip
State
Lic. #
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
. O I am exempt under Sec.. B. 8 P.C.- for this reason
LICENSEDCONTRACTOR'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
-
AMOUNT
25.02
38•W
a.AV
Date Owner
NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should become
ZONE:
_SIGNATURE Y Via _. `"�"` '�/_ Z'•C-%!>.-.-- DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Buslness and Professions Code: Any city or county which requires a
Estimated Valuation
'
-
.-PERMIT '
^•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 thathe 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 five hundred dollars ($500). -
O I, as owner of the property,. or my employees with wages,as their sole compensation, will
Plan Chk. Bal.
Const.
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
Mech.
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 -
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
slruct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
�S-.M.I'. .
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 I am exempt under Sec.. B. 8 P.C.- for this reason
Grading
Driveway Enc.
Dale owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
read this application and state that the above information is correct.
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Date
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
construction, and hereby authorize representatives -of this city to enter the above-
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
Validated by:
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.) - -•
Mailing Address - te_.
I certify that in the performance of thg 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.
AMOUNT
25.02
38•W
a.AV
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
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 Coda.)
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
This is a building permit when properly filled out, sig-ned and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have
^" permit
read this application and state that the above information is correct.
Issued by:
Date
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:
r r
Signature of applicant i t Date
Mailing Address - te_.
Validation:
City, State, Zip
HARD COPY I
T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
� 1i
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SQ. FT.
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.
SQ. FT. ® c
BATH TUB
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
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 APPJEQUIP.
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.
J OOFING �S(�
REMARKS:
f1 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