001920 (RR)4
P.O. BOX 1504 No. 001920
Building 78-105 CALLE ESTADO
Address U 51"741 Fane=z LA QUINTA, CALIFORNIA 92253
Mailing'
Address
City Zip
Contractor
C.V. its .
Address.
P.O. B= 1,256
City Zip
I7`>9�$G2
State Lic.
& Classif.'. ,
Arch., En gr.,
Designer.
Address
922.53
City
Lic. #
Tel.
BUILDING: TYPE CONST. OCC: GRP._
A.P. Number
Legal Description
Project Description'
Sq. Ft.No.
Size- Stories
No. Dw.
Units
New O Add ❑ Alter ❑ Repair O
Demolition ❑
Date Owner '
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become
C
City.
Zip
JState
Lic. #..
Setback
Distances:
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed ,;Under provisioni of Chapfer9 (commencing with Section �^
7000) of Division 3 of. the Business and Professions Code�and/my-license is in full force and
effect.. >J ra 111 e;"
:• •"�-'''
' •
-
_ .. .. ..
SIGNATURE / ?:.--�` /' - DATE
' ;,-'OWNER•BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following¢��
reason: (Sec.- 7037 5,Business' and Professions Code: Any city or- county 'which requires 'a•
permit to consiruct, after;
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT. p
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ, FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SD. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEQUIP.
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
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, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY" •
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ®c
BATH TUB
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT.. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
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
FINAL INSPECTION
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA '
t
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 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.
!1 It ROOFING f �i
VENTILATION
REMARKS:
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