002009 (BLCK)Building
Address"'
Owner
imm Ini. Estr ldi
Mailing "
Address
IaaarfC•
City Zip Ti
La' o41inta 12253
Contractor
Address
City .- Zip T
Of aw IKK4#UUJ--
P.O. BOX 1504 NO. UUZUU!J
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. - OCC..GRP.' '
A.P. Number
1299 Legal Description
Project Description An� F '
State Lic.
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
v
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70 OO) of Division 3 of the Business and Professions Code, and my license is'in full force and
effect...
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for -.the following
reason: (Sec. 703 1..5, Business and Professions Code: Any .city or county which requires a
Estimated Valuation
-
- -
PERMIT
• - AMOUNT -
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):
p I, as owner of the property, or my employees with wages as their sole compensation, will -
-
.Plan Chk. Dep..
- - -
Plan �Chk..Bal.
COnSt.��
•
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
Mech.
,
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
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 of 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
- 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.)
❑ I am exempt under Sec. B. t> P.C. for this reason
Grading
Driveway Enc.
Date Owner �"~ 1
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.
TOTAL
REMARKS
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.
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
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.)
Side Setback from Property Line -
Lender's Name
FINAL DATE
Issued by:
Validated by:
Validation:
A 3 9 3 Z
INSPECTOR'
Date yECTO
�.—p{
1 -23 --"Permit
1 23 39.00 U
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.
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
Mailing Address s'' '' ►
City, State, Zip
'
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINGFEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. I SQ. FT.
WALL SO. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUC—ION 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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
DEC 17
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
DEC 17
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
V87
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL