05354 (BLCK)4
P.O. BOX 1504 No. 0-5354
-5354
Building 78-105 CALLE ESTADO
Address ",_ ,T n D Til LA QUINTA, CALIFORNIA 92253
Owner
ND
Mailing
COAC! VAUEY M BUILDING: TYPE CONST: OCC: GRP.
Address 247 E. TMQUIT #2 A.P. Number i91x..�79�1.t
City Zip Tel.
PALg SPRI 92Zb$ 32214020Legal Description tnt IIA 101t 940 ,1x►it: �S
ContractorProject Description TPVTAT'f7RT(�'_ tTAT1,
MRR CONSIMC'P ON
Address
City Zip Tel.'
State Lic. City
& Classif. 387934 Lic. #�'3 Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City, Zip State
Lic. If
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 r
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirin that I am exempt from the Contractor's License taw for the following Estimated Valuation CL((��
reason_ (Sec. 7031.5,8usiress and Professions Code: Any city or county which requires a 250
permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to fde a signed statement that be is licensed pursuant to PERMIT AMOUNT
the provisions of the contractors License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Cade, or that. he is exempt therefrom, and the bast
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects the applicant to a civif penally of not more than Ove hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractors License Law does not apply to an owner of property who Const.
builds or improves thereon and who does such work himself or through his own employees, Mech.
provided that such rrprovements 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.)
❑ 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. I
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec 8. 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; bra certificate of
Worker's Compensation Insurance, or a certified copy thereof: (Sec:'38t)0. Labor Code.)
Policy No. mpa„ y .?,_; -^', ✓
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS r
WORKERS' COMPENSATION INSURANCE
(This section need not be completed d the permit is for one hundred dollars ($100) valuation , (rte ,i.b;',rr; ;$ ty,g�,(.;�, ,1A' -, q,.,,,,,y •�, •. „� .) i�
or less.) :%''d•- uYiY s-yk J. ,..•-r s s..r.
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 Califomia
Date Owner
NOTICE TO APPLICANT: ff, after making this Certificate of Exemption you should become ZONE: BY:
subject to Me Workers' Compensation provisions of the Labor Code, you must forthwith
conpaywith such PnNJ%10 SorMQpermashallbedeemedrevoked. Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
Ihereby affirm that there is a construction lending agency for the performance of the
work. for which this permit is issued. (Sea. 3097, Civil Code.) Side Setback from Property Line
Lenders Name
Lenders Address FINAL 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. t �$
I certify that I have read this application and state that the above information is correct. Issued by: Datc j 9 Permit
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
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. 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
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 APPJEQUIP.
LAUNDRYTRAY
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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® VVac
HOUSE SEWER
REMARKS:
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
p
FOUND. REINF. /
v
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
'
GARDEN WALL FINAL