002348 (RC)Buildin
Address
78.401 MW M
Owner
� tTS 2 ilf" i�.
Mailing
Address
74-0-47 WV M
City
- PERMIT
Zip Tel.
Contractor
t
Address ..
IZip I Tel.'
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No: 002348
BUILDING: TYPE CONST. OCC: GRP.,
A.P. Number
57 Legal Description
Project Description
State Lic. City
& Classif. Lic. #
Arch., Engr., "
Designer
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
70 00) of Divis�iibma of the Business anndrProfessions.Code, and my license is in full force and
effect.. � l .Y j _/ " T
SIGNATURE / "•^'^' -f DATE
OWNER -BUILDER DECLARATION
1' 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, after, improve, demolish, or repair any structure, prior to its -issuance also
requires the applicant for such permit to 81e a signed statement that he is licensed pursuant. to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Divlsion'3 of the Business arid 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. 1044, 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 himself or through his own employees,
provided. that such Improyements 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 forthe purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct -the project. (Sec. 7044, Businessand 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.
Date Owner
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. I
company
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
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
Ihereby affirm that there is a construction lending agency forthe 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 applicantrt✓ - f%�t �ir"r'�t Dates
Mailing Address
City, State, Zip r'
HARD COPY
Sq. Ft. No. 2rd Story No. Dw.
Size.' Stories Units
New ❑ Add ❑ Alter ❑X Repair ❑ Demolition ❑
Ir*erim altemt&= to exist3.Yltet b .
BY:
Minimum Setback Distances:
Front Setback.from Center Line
Rear Setback from Rear. Prop. Line
Estimated Valuation
74W.00.
Side Street Setback from Center Line
- PERMIT
AMOUNT +`
Plan Chk. Dep.
FINAL DATE
Plan Chk. Bal.
55.15
Const..
68.50
Mech.
1.5.013
Electrical
25.50
Plumbing
A 5 4 9 9.
S.M.I.
:
w
Grading
Driveway Enc.
Infrastructure
TOTAL
166.68
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 Permit
Validated by:
Validation:
A 5 4 9 9.
5 2 X6668 ff
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. 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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1Ya c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
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./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
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION Z�
CERT. OCC.
FENCE FINAL
inarcv i vn o awnM o vncanm i iNw.
GARDEN WALL FINAL