002101 (BLCK)P.O. BOX 1504 No. 002101
78-105 CALLE ESTADO
Address 54"625 AvWlift FWXC! LA QUINTA, CALIFORNIA 92253
Owner .. .. .. .. _ ... _. . .
BUILDING: TYPE CONST: OCC: GRP.
Mailing
Address P -0 -rem 14211 A.P. Number 774-271-018
City Zip Tel.
T.M nillltirt*ft 427914 Legal Description lat 6.
Contractor Project Description
Address
City Zip Tel..
State Lic. City
& Classif. A RQ Lic. # ? r:`£p4'm Sq. Ft.' No. No. Dw.
Size • 230 ' ], .Stories Units
Arch., Engr.,
Designer New Add ❑. Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State 6 ft* high bIM74 Wan
Lic. # . .
w, 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 licensse.,,iss in full force and
effect. . V/ ,T aav-':/i"e r :.• . yr .r,e
SIGNATURE YK T-..... -a ,.: ,r.. r _ •.... �, - - _� DATE .. . . ..
r OWNER -BUILDER DECLARATION' EStlritated Valuation
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 1.250.00
permli to construct, alter, improve, demolish, or repair any structure, prior -to its issuance also
requires requires the applicant for.such permit to rile a signed -statement that he is licensed, pursuant to.. - - PERMIT' - -
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 PlanChk. Dep.. 7
subjects the applicant to a civil penalty of not more than five hundred dollars (S500).. '
O 1, as owner of.the property, or my employees with wages, as their sole compensation, will Plan Chk. Bal. X.92
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 Const. "•5
builds or*irriproves 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 -builder' will have the burden Electrical - _ of proving that he did not build. or fmprove for the purpose of sale.)
O 1, 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. w
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
50
❑ I am exempt under Sec. B. 8 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. O. Certified copy is hereby furnished.
_ TOTAL 3.92
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 ZONE: BY:
subject to the Workers' Compensation provisions of the Lbbor Code, you "must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. - '
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
Lender's AddressFINAL DATE INSPECTOR
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. Issued by: Date Permit
I agree to comply with all city and county ordinances and state laws relating to building,
construction, and hereby authorize representatives<rof this city, -to enter the 'above-.
mentioned property for inspection pyu�frposes r Validated by:
Signature of applicant f .� •" dr,G )ate
—
Mailing Address
Mailin t'f wa.�-.. P -
Validation: /
City, State, Zip `f
A4562.. 3. 6 75,9•._2 ft
HARD COPY 0
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. 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
COLL. AREA
FLOOR DRAIN
MECHANICAL FEES
ROUGH PLUMB.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FORMS
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROUGH WIRING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
DUCT WORK
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
WATER HEATER
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
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 APPJEOUIP.
REINF. STEEL 2 /
80
GAS (FINAL)
TEMP. POLE
GROUT
/l j
C�yfV
WATER HEATER
SERVICE
FINAL INSP.
L;.kOND BEAM %
WATER SYSTEM
$
GRADING
cu. yd.
-Plus-X$-=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
b -S ; DEC
17 Igor
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL