05308 (SIGN)A P.O. BOX 1504
Building78-105 CALLE ESTADO
Address %,Q- 20 H 1WW4AY III LA QUINTA, CALIFORNIA 92253
Owner
14?F'YM roppnPATMN BUILDING: TYPE CONST.
Address PO
C V
City - _ Zip Tel.
n�nJa�r _
Contractor
INNOVATIVE GRAPHICS
Address :
No.
Stories
No. Dw.
Units
_
Alter ❑
833 N.
ELM ST
City
Zip
Tel.:
State Lic.
City
& Classif.
32114215
C-45
LIC. # 130
Arch., Engr.,
Plan Chk. Bal.
Designer
Const.
Address
Mech.
Tel.
City Zip State
Lic. #
I hereby affirm thatd an'i licensed under provisions'of Chapter 9 (commencing with Section
70D0) of Division 33 off a Business and Profession 'Code, and my license,is•in full force and
effect. _ f ti
OWNER -BUILDER DECLARATION
I hereby affirin that I am exemptffrom the Contractors License Law for the following
reason: (Sec. 7031.5,Business andrProtessions Code: Any city or county which requires a
Permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance. also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
fire 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 of 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 hBnself or through his own employees,
provided that'such improvements are not intended or offered .for sale. d, however, the building
orimprovement is sold within one year of completion, the owner -builder wig have the burden
of proving that he did not build or improve for the purpose of 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 hnproves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 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 <tgsself-insure, or a certificate of
Worker's Compensation Insurance, or a certified copy tho6f. (Se'c.3800, Labor Code.)
Policy No. Company a, r ' // i� . F ^ —•-
❑ Copy is filed with the city. - ❑Certified copy is.
fu nis ed.
/
CERTIFICATE OF EXEMPTION FROM
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
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 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.
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
No.
OCC: GRP.
05308
A.P. Number
Legal Description
Project Description TWO r_ saNa 9w4a9 rHxalrt;4v Al -
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE -INSPECTOR
Issued by: Datel/311 l89 Permit
Validated by:
Validati
n. .y y-. ..} ,i �`. 'J s. I';�. ��g• �.�.__ .~'t'1 .'.ki
Sq. Ft.
Size -
No.
Stories
No. Dw.
Units
New ❑ Add Rx
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation 7
50
PERMIT
AMOUNT
Plan 'Chk. Dep.
Plan Chk. Bal.
Const.
21 (A)
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE -INSPECTOR
Issued by: Datel/311 l89 Permit
Validated by:
Validati
n. .y y-. ..} ,i �`. 'J s. I';�. ��g• �.�.__ .~'t'1 .'.ki
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
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. SQ. FT. ®
GROUT
WATER HEATER
WALL SQ. 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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
TOTAL FEES
MICRO FEE
--JDBL
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.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING oe
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL
t
4 4 Qgb&
Address 7(< 7 % I P.O. BOX 1504 APPLICATION ONLY
Building 7&105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address cit2, rs Cie 42rE/
IQ
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number 4! %—' 6`10�
City Zip el.
D
Legal Description
Project Description�J
T (2 I F
s
Contractor 0, l � !� /� �
V v Y
Addres
3.
%ty &E
ajw
zlp�2�otoy
Tel..
J 2
State Lic.
& Classif.aw e& ;
City
Lic. # /3
Sq. Ft.
Size
No. No. Dw.
Stories Units
Arch., Engr.,
Designer
New ❑ Add Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
ICENSED CONT OWS DECLARATION
1 hereby affilicensed under D visions of Chapter 9 (commencing with Section
7000) of Divi and Pro ions Code, and my license I for
�3t
effect • t
GNA1U DATE
P"WBUILDER DECLARATION
I heZy affirm that 1 rapt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8usiness and Professions Code: Any city or county which requires a
permit to construct, alter, Improve, demolish, or repair any structure, poor to its Issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
Me provisbris of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Ofvlsbn 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
Ior the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a ctvilpenally of not more than rive hundred dollars ($500).
❑ 1, 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
Prolessions Code: The Contractor's License Law does not apply to an owner of property who
bne7ds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for safe. It, however, the building
orimprovement is sold within one year or completion, the owner -builder wig have the burden
of proving that he did not build or improve for the purpose or safe.)
Estimated Valuation
J
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
❑ 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) ficensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec -----___B. 8 P.C. for this reason
S.M.I.
Grading
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have a certificate of c sen to se f-11 ora cArtificate of
Worker's r urance, or a certif�o th eo (Sec. 3800, Labor ode.)
Policy No Company
Copy is filed with the l5ity. ❑ Certified copy is hereby fum ed.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This sectiwn need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the perfomtance of the work for which this permit is issued, I shall not
employ any ppeerson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
N017CE TO APPLICANT: fl, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
yWith such Provisions orflus Permit shall bedeemed revoked .
ZONE: BY:
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 Code.)
Side Setback from Property Line
Lenders `Name
FINAL DATE
INSPECTOR
Lenders Aderess
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.
Issued by:
Validated by:
Date Permit
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
FINANCE
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