001743 (SIGN)44 A-
P.O. BOX 1504 No, 001743
Building 78-105 CALLE ESTADO
Address 78`401 EW 132 LA QUINTA, CALIFORNIA 92253
Owner
rDimm Savinm BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address its— 11 A.P. Number
City Zip Tel.
la QUIlfta 92253 564-6661 Legal Description
Contractor. Project Description n4o t0==Z V wwwiod
Be4t -.a ms
Address ...
26M 1-hy
'City Zip Tela -
friTM5 92269 328-6275
State Lic. City
& Classif. Lic. # applied Sq. Ft. ; No. No. DIN.
•Arch., Engr., - - - - --
Size • - Stories Units
Designer New W 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) of4Dfvision 3'of the Business and Professions Code, and my license is in full forceand
effect. �+
SIGNATURE "`Y- / ,Y K -J DATE
%-'OWNER-BUILDER DECLARATION EStiinated Valuation w
I hereby affirm that I am exempt from the Contractors License Law for the.following ..nq
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a • 00
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also AMOUNT
requires the applicant for such permit to file a signed statement that he is licensed,pursuanf to �. PERMIT -
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 or 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 properly, or my employees with wages as their sole compensation, will Plan Chk.. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness-and COnStQV t,
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, 'Mach. '
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.) -
O 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.1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading
0. 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 of consent lo-.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.. ❑ Certified copy is hereby furnished.
TOTAL 21D.00
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 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.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
'subject -to the' Workeis' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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 car tify-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 'r. G
Mailing Address
City, State, Zip
HARD COPY
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:
Date 10'-7 Permit
-'Validated by:
Validation:
A 2 8 U 7
10 7 20,00 Ck
v� '
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
2ND FL. SQ. FT. ®
POR. SQ. FT. ®
GAR. SO. 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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
LAUNDRY TRAY
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.
SQ. FT. ®c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 34c
HOUSE SEWER
REMARKS:
VENTILATION
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.IEQUIP.
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
— NAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL :d