003064 (BLCK)N �
P.O. BOX 1504 N O. 003064
Building 78-105 CALLE ESTADO
Address 54-660 Avenida Pubic) LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST: OCC: GRP.
Mailing
Address 81--495 Av 1 , 'i A.P. Number 774-272-00a
City Zip Tel.
A1lain.��� Legal Description
Contractor Project Description 31 High Retai Lina wall
Address
City . Zip Tel:
State Lic. City
& Classif., Lic. # Sq. Ft.'�- Na. No. Dw.
Arch., Engr., - _
Size Z " Sttories Units
Designer New O' 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
I hereby affirm that I am exempt from the Contractor's License Law for the following $1,F800 . vii '
reason: (Sec. 7031.5,Business and Professions Code: Any 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 rile 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 '•r••
Division 3 of the'Business. end Professions Code, orthat. he,is.ezempt therefrom, and the basis -
for the alleged exemption. Any violation of Section 7031.5, by 'any applicant for a permit Plan. Chk. Dep. �•f
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).. � : - - Plan Chk. BBI.
O I, as owner of the property, ormyemployees with wages as their sole compensation,.will
do the work, and the structure is not intended or offered for sale. (Sec. 7044; Buisness and Const..
Professions Code: The Contractors License Law does not apply, to an owner of, property who
builds or improves thereon and who does such work himself or through his own employees, Mech. -
provided that' such. improvements are not intended or offered for sale.. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden ' Electrical
of proving that he did not build or Improve for the purpose of sale:) , _ -
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
struct the project. (Sec: 7044, Business and Professions Code: The Contractor's License Law ttff
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. a 5il?
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
0. 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date �'7! �Owner l r! f' d ✓� 3•-f.4r`°Infrastructure
r c34.r1v1t4R_"!i<I;44 A')401 ? k$ x_ "d
WORKERS' COMPENSATION DECLARATION y
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
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 lhp 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- f/
d+ l7�!'�
NOTICE'TO APPLICANT. If, aftei'makiggl tnis•'Certificate 0%�'Ex'emption you should become ZONE: BY:
subject to the Workers'Compensationprovisions of the Labor 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 4
Lender's Address
This is a building permit when properly filled out, signed and .validated, and is subject to FINAL DATE INSPECTOR
expiration it work thereunder is suspended for 180 days. o
I certify that I have read this application and state that the above information is correct. Issued by: Date /'/SRermit
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. Validated by:
Signature of applicant Date
Mailing Address
Validation. .
City, State, Zip
HARD COPY
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
. -
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
HEATING (ROUGH)
2ND FL. SQ. FT. ®
FORMS
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO, FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. Q. FT. ®
OTHER APP./EOUIP.
DRAINAGE PIPING
WALL SQ. FT. ®
TEMP. POLE
DRINKING FOUNTAIN
SQ, FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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.
SO. FT. ® c
BATH TUB
GAR. FIREWALL
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
MESH
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICROFEE1
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
OUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
Vjt�F. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
OND BEAMS : —j�
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
INSULATIONISOUND
FINISH GRADING
.FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL