003198 (PAT)P.O. BOX 1504 No. 003198
Building 78-105 CALLE ESTADO
Address ' 52-$94 Aida Rubio LA QUINTA, CALIFORNIA 92253
Mailing
Address
City Zip Tel.
Cu xtta. 52253
Contractor
Address
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description ShiCde Aiyrdi -ast.
city..
Zip
Tel.. _.
State Lia
City
& Classif.
Lic. #
Sq. Ft.
No. No. Dw.
Size
Stories Units
Arch., Engr ;.
Designer
New ❑ 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 full force and -
effect:
SIGNATURE DATE
_
OWNER -BUILDER DECLARATION
EStlmated,.ValUatlOn
I hereby affirm that I am exempt from the Contractor's License Law for the following
7031.5,Business Professions Code: Any
.
reason: (Sec. and 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
PERMIT
- - AMOUNT
the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
.�
Division 3 of'the Businessand'Professions Code, or that. he is exempt therefrom,'. and the basis
for the Any Section 7031.5 by 'any for
Plan Chk-. Dep.
-
alleged exemption. violation of applicant a permit-
' subjects the applicant to a civil penalty of not `more than five hundred dollars -($500). - '-
Plan Chk. 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,
MecIr.
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 '
- 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
. . ❑ I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date ,r"/_,_N Owner - "�F'
Infrastructure
WORKERS' COMPENSATION DECLARATION
P 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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation -
- or less.) - -
certify that in the performance of the work for which this permit is issued; I shall not
%} l�,} 10 5f+y7 S1 C46 •30 19 71 „� ,�..., 10
.—employ any person in any manner so as to become subject to the Workers' Compensation •
-
a r. r„rycr� ,, ..::::�__ .. �•� ..
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 Address
City, State, Zip
HARD COPY
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-6/9IA/97 Permit
Validated by
Validation:_
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ, FT. ®
CAR P. SQ. 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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
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 ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
4
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
CERT. OCC.
FENCE FINAL
snarc�n un a anonw l V nCWINI i iNw_
GARDEN WALL FINAL