11529 (BLCK)P.O. BOX 1504 ( N o . 11529
Tilt
Building 78'105 CALLE ESTADO t .(,No.
�
Address 46--100 1/2 Hwv Ill LA QUINTA, CALIFORNIA 92253
Owner
L
Mailing
`SDC BUILDING: TYPE CONST. - OCC: GRP.-
Address 2377 Crenshaw Blvd. Ste. 300 A.P. Number
CityZip Tel.
Torrance, Ca 90500 610-3600 Legal Description
Contractor Project Description Decorative entry walls at
Na CAILa Qu3n.ta entrance Simon entrance and
Address e •
600 Cpntra Ave- B l Aa A corner of wash.i-naton and Hwy 3.11 at . thp_
City Zip Tel.:
'Lake Rlsillor 1 925301 245--54010 Walmart Eenter _ 230' of 61 and 12-01 of 1.
State Lic. City -Fv t W a4J>iAt
& Classif. Lic. # J
p� 23�0'Y� ,� 52 sq. Ft. ZP�Yt +mitt. No. No. Dw.
Arch., En r.- Size �'s t•� '1 /.� ¢ZJ,Stories, l rUhits ( ,,, `
:.� Designer �\ New ❑ Add ❑ "ARVEr Repair ETDemolition ❑
Address Tel. iti7l2j.� tea,
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. y
_SIGNATURE C .! ^ 1.�,:+•" DATE
iY
OWNER -BUILDER DECLARATION Estimated Valuation nq ,
I hereby affirm that 1 am exempt from the Contractor's License Law for the following $7,000.00 7 O. �Q
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a '`1 , vv>J
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) or
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. Dep. ..
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Plan Chk. Bal.
❑ 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 Const.20.00
*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 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. 'a €a
• such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under. Sec. B. & P.C. for this reason
Driveway Enc.
Date owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I'have a certificate bf consent to self -insure, or a certificate of
Worker's Compensation Insurance, ora certified copy•thereo_f'(Sec. 3800, Labor Code:) i
Policy NO.-' Company 4' •�' +� % /i./ sR3i �? f
Copy is filed with the cit. ❑Certified copy is hereby furnished. - �-
TOTAL 90.70
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
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 or 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
•'��Cirif#`,7k.+l3't s�Qr'n#r+�:€1••�^9—�i?.�r; •+•� �i)
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: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
FOR. SQ. FT. ® t '
GAR. SQ, FT, ®
CARP. SQ. FT.
WALL ' SQ. FT. ®
SQ, 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 APPJEOUIP.
- LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U. —
- SQ. FT. RESID ®1+/A c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
HOUSE SEWER -
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE MECH.FEE
PL.CK.FEECONST.
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. 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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL