002531 (RC)44 �I%Gifl�Ifi�J
P.O. BOX 1504
Building �, , 401 HiCA ' n1 te LA QUINTA78-105 CCAL CALIFORNIA 92253
Address
Owner
Mailing
Address
City
Zip fel(E?�C,
Contractor
Address
City`" • . Zip Tel."' "
TA alinta 92253 564-0460
No. 002531
-BUILDING: TYPE CONST. • wt o OCC GRP
A.P. Number
Legal Description
Project Description
State Lic.
& Classif.
City
Lic. # 672
Sq. Ft.
Size 750
No. No. Dw.
Stories - Units
-
Arch.; Engr:;.. .
Designer
New 0 Add ❑
Alter Ch' Repair ❑ Demolition ❑
Address
Tel.
Rear Setback from Rear Prop. Line
City
Zip
State
Lic. #
I hereby affirm that there is a construction lending agency for the performance of the
��X til!?ZZi==$i >i FL:t�w
y ' LICENSED CONTRACTOR'S DECLARATION_-• • _- .
I hereby affirm that m licensed under provisions of Chapter (commencing with Section
.7000) of'Division�3 of the Busin- and Professions Code, and my license is in full forcelrand
effect.
r•..,._...
Side Setback from Property Line
... ..
'
....
SIGNATURE -.Lbw...-••^',,' ..w-. _.
` A `-DATE
OWNER -BUILDER DECLARATION "
j 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, pnor',to its issuance also,,
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.applicantto a civil penalty of not more than five hundred dollars ($500). '--
O I, as owner of theproperty,or m em to employees with wages as their -sole compensation, will
. Y P Y 9 P
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 himself or through his own employees,
provided that' suchimprovements 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.) -
D 1, 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
projects with a contractor(s) licensed pursuant to the Contractor's License taw.) -
D I am exempt under Seca B. & P.C. for this reason
Estimated Valuation
• 11..7. s
PERMIT
-- AMOUNT
7
Plan Chk. Dep.
-
Plan Chk. Bal. •,
..
75.72
•
Const.
116.50
Mech.
.
MOO
- •
Electrical
•�
.. .
Plumbing
Validated by:
S.M;I.such
-
Grading
Validation:
Driveway Enc.
City, State, Zip
Date Owner
Infrastructure
/
WORKERS' COMPENSATION DECLARATION
A hereby affirm that I have's 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
O. Copy is filed with the city. D 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 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.
8 8 i 1 9, 3 1 CK
TOTAL
y�
21901
REMARKS
Date Owner
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become
BY:
subject to the 'Workers' Compensation provisions of"the Labor Code, you must fo:rhwith
comply with such provisions or this permit shall be deemed revoked.
.ZONE:
,Minimum Setback Distances:
Front Setback from.Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side StreetSetback 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
Lender's Name
Lender's Address
' This is a building permit when properly filled out, signed and validated, and is subject to
FINAL DATE
INSPECTOR
expiration if work thereunder is suspended for 180 days.
I certify that I have this
°"K+
read application and state that -the above information is correct:
I
Issued by:
Date Permit
agree to comply with all city and county ordinances and state laws relating to building..
construction, and hereby authonze,representatives -of this city to enter the above='
mentioned property for inspection purposes. �',/f_
�> w"
Validated by:
Signature of applicant .,400 �',r,+•+ Date - 1J�
Mailing Address
Validation:
City, State, Zip
/
A 6 1 6 1
8 8 i 1 9, 3 1 CK
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
2ND FL. SQ. FT.
POR. SQ. FT. @
GAR. SQ, FT, @
CARP. SQ. FT.
WALL SO. 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
WASH ER(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, 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 @ 11/. c
SEWAGE DISPOSAL
if
/
/
SQ.FT.GAR @ 3/ic
HOUSE SEWER
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE IPL.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
if
/
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
F SH GRADING
SPECTION'2
CERT. OCC.
FENCE FINAL
IIV3Ytli IV PVZo W WAA I UnrWI VI I IALJ_
GARDEN WALL FINAL