003423 (BLCK)Y
2
Building
Address
Owner
Mailing
Address
City
. -. La
Contractor
ress
54-820 Carranza
p
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No.. 003423
BUILDING: -TYPE CONST. OCC: GRP.
A.P. Number 774-295-004-
Legal
74-295-004Legal Description
Project Description R4ataini ltea WA 1.-1
'City
Zip -
Tel..
State Lic.
City
& Classif.
Lic. #
Sq. Ft.
No. No. Dw.
Size
Stories Units
' Arch'.; Engr:;
Designer
New ❑ 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
,. 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 Valuation
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'2
749
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
PERMIT
AMOUNT
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
Plan Chk. De p
^
subjects the applicant to, a civil penalty 'of not more than five hundred dollars.($500).
Plan Chk.
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
Bal.
do the work, and the structure is not intended or offered. for sale. (Sec. '7044, Buisness and
'not
COr1St
Professions Code: The Contractor's License Law does apply, to an owner or 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 have the burden
Electrical
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.I.'
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) • •
Grading
-
❑ I am exempt. under. Sec.B. 8 P.C. for this reason
Driveway Enc.
Date f"' = '• .7 owner f rF 'ti," �'a-^f:'-°3
Infrastructure
WORKERS' COMPENSATION DECLARATION '
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. 0 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 ($100) valuation
-
• or less:) -
I certify that in the performance of thg work for which this permit is issued, I shall not
"•
-
AVS
employ any person- in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date' Owner•
NOTICE TO APPLICANT: R, 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=firm that thereisa 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 if work thereunder is suspended for 180 days.'
I certify that I have this
�y y 1 �q
U L f Permit
read 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:
Signature of applicant --Date-
ateMailing
MailingAddress
Validation:
City, State, Zip
I HARD COPY
LT
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
S
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. ®
FORMS y
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. SO. 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
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE7FEE
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 y
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
,
GARDEN WALL FINAL