003842 (RPL)44
P.O. BOX 1504 No.. 003842
Building 78=105 CALLE ESTADO
Address 54-845 Rubio LA QUINTA, CALIFORNIA 92253
Owner
Mailing
" t "ps �'3"AV BUILDING: TYPE, CONST. " OCC: GRP.
AddressA..P.,Number 77,4-2191.«.017
City Zip aTel.
_ La Onin1ka 92253 - _ Legal Description
Contractor Project Description P601 & 8pa
9rtt,�f�4'r>rst< �nrt97
Address _
43a-375 Madison Stueet
.City Zip :- Tel..
7[nd o 92201 34",'-5 5
State Lic. City
& Classif. 348768 Lic. # 34. _ , Sq. Ft. No. No. Dw.
Size Stories Units
Arch:, Engr:, ... •
Designer New ❑ Add ❑ Alter ❑` Repair ❑ Demolition p
Address Tel.
City Zip State
.. .. Lic.#
LICENSED CONTRACTOR'S DECLARATION T
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing withSection
7000) of Division 33�of the Business and Professions Code,' and my license is in full force and
effect. . "11:001 _ :✓".•.._ . . . . . /}- Z > . v^
_.
SIGNATURE - DATE .. .. . - .. .
OWNER -BUILDER DECLARATION Estimated .Valuation "
I hereby affirm that 1 am exempt from the Contractor's License Law for the following $121500
reason: (Sec. 7031.5,susiness and Professions Code:'Any city or county which, requires a -
Permit to constnrct. 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 f.
Division 3 of the Business and Professions Code, or that:heis exempt therefrom; and the basis. -.. -
for the-affeged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk..Dap. ••
subjects the applicant to'a civil penally of not more than five hundred dollars ($500): 4 4 p '
❑ 1, as owner of the roe y _ y g p Plan Chk. Bal 2
p p rty; or m employees with wages as their sole compensation, will n w
do the work, and the structure is not intended or -offered for sale. (Sec: 7044, Buisness and onst. 70 .�>�
Professions Code: The Contractor's License Law does not apply to an' owner of property .who •
builds or knproves thereon- and who does such work himself or through his own employees, - 20.00.
,
provided that such improvements.are not intended or offered for sale. If, however,. the building Mech.' -
or improvement is sold within one year of completion, the owner -builder will have the burden EleCtrlCdl -
of proving that he did not build or improve for the purpose of sale.) '
1101
❑ 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
-does not apply to an owner of property who builds or improves thereon, and who contracts for S.M:I. - ' ' .88
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
.. O lam exempt under Sec. - B. 8 P.C.•for this Grading 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.. . ❑ 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) valuationv kT {!�`,'> # t''! -i3'7. 17 !tA _.11 -:PR 4A
or less.) .
. i
I certify that in the performance of thg work for which thispermitis issued, I shall not - - � �` . t..U tr':I• -I rTrt'w. 4 2 1 +i- C>a)
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California
Date ' - 'Owner _
NOTICE TO APPLICANT: t, after making .this Certificate of Exemption you should become ZONE: BY: '
subject' to" the Workers' Compensation provisions 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. 309 7,Civil Code.)- - Side Setback frOJT1• Property Line
Lender's Name
Lenders Address FINAL DATE INSPECTOR.
This is a building perm -it when properly filled out, signed and validated, and is subject to 4113/8O
expiration if work thereunder is suspended for 180 days. '-a
I certify that I have read this application and state thatthe above information is correct Issued by: Date O Permit
i agree to comply with all city and county oidinances 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
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT. p
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ, FT, ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®
DUCT WORK
DRAINAGE PIPING
WALL SO. FT. ®
GAS (ROUGH)
DRINKING FOUNTAIN
SQ. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
TEMP. POLE
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER HEATER
SERVICE
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
FINISH GRADING
GAS PIPING
PERMIT FEE
FINAL INSPECTION
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 APP./EQUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS,
GARDEN WALL FINAL
I