08054 (SFD)°
4
'o P.O. BOX 1504 No. 08054
Building �r�� - 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Mailing
A M Com$ruction BUILDING: TYPE CONST. OCC: GRP.
Address Row '294 A.P. Number 7mms-nag A nip
CityZip Tel.
La nta 53 554-5832 Legal Description
Contractor Project Description 1gJnt IF"ll t N**111glim
r
Address
City Zip Tela
4 RGER
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
! LICENSED CONTRACTOR'S DECLARATION
I hereby affirm tht�r I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 gf the Busintss and Professio de, and my license is in full force and
effect. ( "I
I OWNER -BUILDER DECLARATION
I 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 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 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. 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. 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.)
❑ I, as owner of the property, am explusively 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 propepy who builds or improves thereon, and who contracts for
such projects with a contractor(s) licens d pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. 713. & P.C. fty this reason
Date Owner
WORKERS' COMPEI
I hereby affirm that I have a certifica
Worker's Compensation Insurance, or a cert
Policy No. Company —
❑ Copy is filed with the city. ❑ Certif
DECLARATION
sent to self.insur qq��, �a certificate of
the 9rtJbor Code.)
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.
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
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
ateMailing Address
City, State, Zip
Estlmatea valuation
PERMIT AMOUNT
Plan Chk. Dep.
50.00
Plan Chk. Bal. ..
Const. 81,00
Mech.
Electrical
Plumbing
S.M.I. Q
Grading
Driveway Enc.
Infrastructure
TOTAL R1 _ itrll F'i't N _R41 A7
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 5Qn Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE 7/3 ,ep /,4
2ND FL. SQ. E -f.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. Ff.
GAS (ROUGH) � Lf n
l/
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING ?1,2o
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROOFING
/�
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/. c
SEWAGE DISPOSAL
FINISH GRADING
SO.FT.GAR ® 3/ic
HOUSE SEWER
FINAL INSPECTION 0 ZQ
Ll
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEESMICRO
FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK ? O I;JC.�
GROUND PLUMBING 6/02V
ERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 7/3 ,ep /,4
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
6GWF =@R SEPTI NK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. 71.71*
GAS (ROUGH) � Lf n
l/
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.
p
FRAMING ?1,2o
FINAL INSP. %O arg
ROOFING
/�
��
4/
I
/I�%`% 400?/ �
0
Y� Aee
7
` p
D
REMARKS:
I
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHINGM4/A/
MESH
INSULATION/SOUND ��
FINISH GRADING
FINAL INSPECTION 0 ZQ
Ll
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL ::d