003567 (RR)-.P.O. BOX 1504 NO. 003567
Building 78-105 CALLE ESTADO
Address 49-910 Lago Drive. LA QUINTA, CALIFORNIA 92253
Owner
Mailing BUILDING:- TYPE CONST. OCC: GRP.
Address Sam A.P. Number 631-400!-023
City Zip p Tel.
(tinta 42253 Legal Description
Contractor
Project Description RE'"i"t1C?f
Arzr�carr�c� Rt�ttl�st . IIIc _
Address
-3584 La Campana Way
CityJZip Tel.
Palm 5oxiarn 322652 325-8304
State Lic.
& Classif... 471881
-Arch., Engr.,
Designer.
Address
City
Lic.'# Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Tel. _
City
Zip
State
hereby affirm that there is a construction lending agency for the performance of the
-
Lic. #
LICENSED CONTRACTOR'S DECLARATION
l
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.
.,,^�" '...-'• •' .r ,�, � t`: rte,.- .
SIGNATURE" -DATE
/' i OWNER -BUILDER DECLARATION
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, prior to its issuance also
requires the applicant for such permit to lila 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 applicant to a civil penalty of not more than five hundred dollars ($500).. -
O I,. as owner of the property, or my employees with wages as their sole compensation, will
_ _ .--• -
Estimated Valuation32Q�
PERMIT - AMOUNT
-
Plan Chk. Dep. -. -
Plan. Chk. Bal.
COf1St. - ti
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 such improvements are not intended or offered for sale_ 1f, however, the building .
Mech.
Electrical '
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 o! sale.) -
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
-
S.M.I.-
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
Grading
,
Driveway Enc.
mentioned property for inspection purposes.
' Date owner
Infrastructure
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. . ' Company
❑ Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS'. COMPENSATION INSURANCE
REMARKS
(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
ry
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.
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
hereby affirm that there is a construction lending agency for the performance of the
work •for which lhispermit is issued. (Sec.'3097, Civil Code.) -
Side Setback from Property Line '
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
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.1)
I88
I certify that I have read this application and state that the above information incorrect.
*City
Issued by:
Date d i Permit
I agree to comply with all 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.
Validated by:
Signature of applicant— Date
Mailing Address
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL.SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. Q. 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 APPJEQUIP.
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 ® 1Ya c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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 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
INSULATIONISOUND
FINISH GRADING
L
(�<FINAL INSPECTION
CERT. OCC.
FENCE FINAL
I UM'J WUNA I UKLWINI I IAUk
GARDEN WALL FINAL