001704 (BLCK)•4 9�
• P.O. BOX 1504 No. 001704
Building 78-105 CALLE ESTADO
Address 53-710 Mbio LA QUINTA, CALIFORNIA 92253
Owner _ . ..
Mailing Joe R BUILDING: TYPE CONST. - V -N. OCC: GRP.-- R 3
Address 53-710 R&io A..P..Number 774—U3-010
City15
Mttl;Zip Tel.
.. rAOIL92253 Legal Description
ContractorProject Description • ft. ' Qf 6- ft• hic�i h1 'vilaU
at7! 1fi7Mt1{0WMr
Address, 34- U3. ft. of 3 ft high LICCk wall
sa
City Zip Tel.. _ ..
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 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
Estimated valuation S4 260.00.
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, atter, improve, demolish, or repair anystructure, prior to its issuance also c • -
requires .the applicant for such permit to rile a signed statement that he is licensed pursuant -to - PERMIT'- .. •.� AMOUNT
the provision of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of '
Division 3 of the Business and Professions Code, or that. he.fs exempt therefrom, and -the. basis -
for the -alleged exemption. Any violation o/ Section 7031.5 by 'any applicant for, a permit Plan Chk. Dep.
subjects the applicant to a civil penalty o/ not more than five hundred dollars ($500). - - y -
• ❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan•Chk. Bal. 6
92
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisne'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, .M@Ch.
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 o/ sale.) -
O 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 - •n
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. 4+
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.
t
Date owner V ; -+ . J, Infrastructure
1. t/
WORKERS' COMPENSATION DECLARATION
Ihereby 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
- O Copy is filed with the city.. O Certified copy is hereby furnished. ,
TOTAL $3.82
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.) — -
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.
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 COPYI
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"°`5"g5 Permit
Validated by:
Validation:
A2515
9 5,
8382 Ck
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. @ $
2ND FL. SQ. FT. @
POR. SQ. FT. @
GAR. SQ. FT. @
CAR P. I SO. 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
WASHER(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, 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 VA 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 JELECT.FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
A
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
TANK
ffROCK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
RAGE
FOUND. REINFl.� //
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
Y
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM ��p j�
III
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 5/7
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL