001602 (PLBG)P.O. BOX 1504 No. .001602
Building 78-105 CALLE ESTADO
Address 51-045 AyImida Mvi= LA QUINTA, CALIFORNIA 92253
Mailing
BUILDING: TYPE CONST.
OCC: GRP.
Address P.O. � 1�i«.
A.P. Number
City Zip
Tel.
92253
%4-4M7
Legal Description
Project Description
Contractor
A—E. G?1
Issued by:
Date Permit
Address_ -
.
City. Zip
Tel.
81877
7 i0 40.00 CK
Elp—mart. 92240
329-6875
State Lia.
City
& Classif.. ?5�1
Lic. #
Sq. Ft. No.
Size Stories
No. Dw.
Units
Arch., Engr.; -
Designer
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition ❑
Address
Tel.
yt ap 11lr%n e%f a
w 04•v r,
City
Zip
State
Lica#
_. LICENSED CONTRACTOR'$ DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Divis on 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. 7031:5, Business and Professions Code: Any .city or county which .requires a
permit to construct, alter, improve, demolish, or repair any structure; prior',lo: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 applicantfor a. permit
'subjects the applicant to a civil penalty -of not more than five hundred dollars'($500).
❑ 1, as owner of the property, or my. employees with wages as their sole compensation, will
Estimated Valuation
PERMIT
'a
AMOUNT
Plan. Chk-. Dep.
,.
Plan Chk. Bal. .
COf1St.
-
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
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.
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.) ..
Mech.
..EIQCtrICal
Plumbing
O 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
such projects with a contractors) licensed pursuant to the Contractor's License Law.) -
O I am exempt under Sec. B: 8 P.C. for this reason
S.M.I.
Grading
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
' 1 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
O 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
-orless.) '
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
subject to the Workers' Compensation provisions of the Labor Code; you must forthwith
. comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and'validated; and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that ( have read this application and state that the above information is correct.
1 agree to comply with all city and county ordihances 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 .a _ /f• r .. Date 7- f `r
Mailing Address
City, State, Zip
HARD COPY
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from.Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
81877
7 i0 40.00 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
ROUGH PLUMB. BONDING
2ND FL. SQ. FT.
STORAGE TANK
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SQ. FT.
REINF. STEEL
DRAINAGE PIPING
WALL SQ. FT.
DRINKING FOUNTAIN
SQ. FT. ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
LUMBER GR.
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
II
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
i
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
C
EWER ORS A K 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
Ij
��ti 01 `' 1 AJ r'I/
y
`� h (l/ S C P I1gr.
`^f �• � I
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
.GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL