002298 (SIGN)Building
Zip
Address
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Owner
LICENSED CONTRACTOR'S DECLARATION
Ykmof
Mailing
SIGNATURE' " - DATE
Address
?8-4
City
.O
Contractor
COnSt.s�
Mech.
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.)'
Electrical}^f
Address
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
• strucl 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.)
❑ I. am exempt under Sec. B. & P.C. for this reason
S.M.L. 51 -,
46-2.
City
C .
Date Owner
State Lic.
f 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
& Classif.
2071
Arch., Engr.,
D
Q Copy is filed with the city. O Certified copy is hereby. furnished.
P.O. BOX 1504 N0, 002298
78-105 CALLE ESTADO
"83 Aw M LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
r 3 1 A.P. Number
p Tel.
92201 --•62.241 Legal Description
Project Description
t�.r� t'7dx1±i
241 �' 49 ' A ' pl%.arm .
c�! St.
Zip'
2201
Tel.-
?--3566
City
Lic. # 223
i°Uminatsd, as
Sq. Ft. No. No. Dw.
Size Stories -Units
eslgner rvcw UX. AUU u Alter'Li neNdn u Demolition 0
Address Tel.
plot Plan��--2'S Mist be amplied with
City
Zip
State
Lic. #
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that.) am licensed underprovisions 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. °•A
SIGNATURE' " - DATE
OWNER -BUILDER DECLARATION
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 alsoAMOUNT
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 penally of not more than live. hundred dollars ($500): *
❑ I, as owner,of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
. Professions Code: ,The Contractor's License Law does not apply to an owner of property who
Estimated Valuation
rpt nrt
n
° PERMIT' -
'
Plan Chk. Dep.
-
Plan Chk. Bal. _ 68.50
COnSt.s�
Mech.
builds or improves thereon and who does such work himself or through his own employees,
provided that' such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)'
Electrical}^f
Plumbing
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
• strucl the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or, improves thereon, and who contracts for
- such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I. am exempt under Sec. B. & P.C. for this reason
S.M.L. 51 -,
Grading
Driveway Enc.
Date Owner
Infrastructure
f WORKERS' COMPENSATION DECLARATION
I hereby affirm that' I have a certificate of consent to self -insure, -or a certificate of •
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. ' Company
-
1 L
Q Copy is filed with the city. O Certified copy is hereby. furnished.
TOTAL„
REMARK$
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one dollars ($100) valuation
•• or less.) , i . • • .
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.
r
'Date' Owner
NOTICE TO APPLICANT:If, after making this Certificate 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
Thereby 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 Street Setback from Center Line
$Ide Setback from Property. Line
Lender's Name
FINAL DATE INSPECTOR
(..q �. 06t
Issued by: Date 1 Permit
, Validated by:
_
Validation:
A 5 2 0 8 4 11 x.4355 Ch
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. {,+o-•-- /7 f'�
Signature of applicant''`!-• f✓,••0-ps.- Date
Mailing Address
city, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. Q. FT.
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
IHOUSE SEWER
REMARKS:
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 APP./EQUIP.
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
NSP.
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 :d