002435 (RR)P.O. BOX 1504
Building 31-630 Awa Rubio78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address Sam
City Zip Tel.
La. Quitta. .92253
Contractor
C.M. rMfiW, Cb.
Address r ..
No. 002435
WILDING:- TYPE CONST. OCC: GRP.
t.P. Number
.egal Description
'roject Description
P.O. B= 1256
I3Y:
Minimum Setback Distances: -'
City ..
Zip
Tel..
Rear Setback from Rear Prop. Line
Side Street Setback. from Center Line
Side Setback from Property -Line
FINAL. DATE
State Lic.
City
Date 6" 3 Permit
Validated by:
& Classif. 352007
Lic. # 319
Sq. Ft.
No. No. Dw.
A588Z
6 30 3a00 U.
Size
Stories Units
Arch., Engr.;
Designer
New q 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) of Division 3 of the Business and Professions Code, and my license is in-fullforceand
effect..
SIGNATURE r.., a'rs..., .A;_$./' ..DATE
' OWNERwBUILDER DECLARATION
I hereby affirm that I am exempt from the contractor's License Law for the following��
Estimated Valuation
'
reason: (Sec.. 7031.5,Business and Professions Code: Any city or county which requires, a
-to
A
permit construct, after, 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
PERMIT
AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division' 3 o the Business and Professions Code, or that: he is. exempt therefrom, and the basis
for the alleged exemption. Any Section 7031..5. by 'any. for
Plan-Chk: Dep.. -
-
•
violation of applicant a permit.
' subjects the applicant to a civil penally'of not more than five hundred dollars ($500).'
Plan Chi<. Bal.
❑ 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
Const.'��
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,
Mech.
'
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•bullder will have the burden
_
Electrical
'
of proving that he did not build or Improve for the purpose of sale.) - ,_
❑ 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.I.
• such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 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 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.. ❑ 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.
Dale 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 r ; ,-..,. Date f �'
Mailing Address �.
City, State, Zip
HARD COPY
TOTAL30.00
REMARKS
ZONE:
I3Y:
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 6" 3 Permit
Validated by:
Validation:
A588Z
6 30 3a00 U.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SO. 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 APPJEQUIP.
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 ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR Q 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 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.
ROOFINGetj( kj�3V /
Jo
i
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
'
FINISH GRADING
06INAL INSPECTION(
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL ::1
-
2 r: