001749 (BLCK)Building
Address
Owner
Mailing
Address
City
Ta MATT
Contractor
Address
City
State Lic.
& Classif.
Arch., Engr.,
.Designer
Address
Zip Tel.
Zip' Tel. `
City
Lic. #
Tel.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST: L` OCC: GRP. R 3
A.P. Number 773-I25--024
Legal Description L40t12
Project Description
lin. ft. of Gam$» hich "
Sq. Ft. No.
Size • Stories
No. Dw.
Units
New R Add ❑ Alter ❑ Repair ❑ Demolition ❑
City Zip State
- Lic. #
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencingwith Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect. .
_SIGNATURE DATE .. _ _ • . , . .
OWNER -BUILDER DECLARATIONEStlmated Valuation
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions. Code: Any city or.county which .requires a;:
permit to construct, atter, improve, demolish, or repair any structure;' prior to its issuance also • "
requires the applicant for such permit to file 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 isexempt theiefrom, and the' basis '
for the alleged exemption Any violation of -Section 7031 5 by 'any :applicant for a permit . Plan Chk. Dep. '
' subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
- ❑ I, as owner of the property, or, my employees, with wages as their sole compensation, will
Plan Chk. Bal.
Const.
'
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
M2Ch. '
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
Electrical -
• 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.) I I. .
Plumbing
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
- strucl- 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.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)- - -
❑ 1 am exempt under Sec. B. & P:C. for this reason r
Grading
Driveway Enc.
Date Ownerl%•/
Infrastructure
WORKERS' COMPENSATION DECLARATION
Validation:
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.)
1L 16 2QLG _CK
Policy No. Company
❑ Copy is filed with the city. - O Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM.
WORKERS' COMPENSATION INSURANCE. .
REMARKS"
(This section need not be completed if the permit is for one hundred dollars (S100)'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, alter 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 if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
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. r�
Signature of applicant -J �.; � f "%' bate
Mailing Address t
City, Slate, Zip
HARD COPY
AMOUNT
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 III --t Permit
Validated by:
Validation:
A2897
1L 16 2QLG _CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FBWS
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. p
GAR. SQ. FT. ®
CARP. SQ. FT:
WALL SQ. FT.
SQ 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 APP./EQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
ti
SQ.FT.GAR ® 3/ac
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
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
ti
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
' FENCE FINAL 5 s �Lf.
INSPECTOR'S SIGNATURESANITIALS.
GARDEN WALL FINAL