002055 (GRES)4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 52'-108 Awrxida iRamirm LA QUINTA, CALIFORNIA 92253
Owner
No. 002055
rRm=d NoCanahay
BUILDING: TYPE CONST.
OCC. GRP.
Mailing
Address 521.-1ilfi A 4r3a „i
A.P. Number 773-222-023
Legal Description
Project Description
is 15
City
TA a
Zip
-92253
Tel. .
564 -4209
Contractor
Address
City
"n
Zip
Tela -
x.M
9"01
341349
State Lic.
City
& Classif. Ann71 `1
Lic. # Sri
Sq. Ft.
-Size
No. No. Dw.
Stories Units
Arch., Engr.,
Designer
New Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
a�st°il1F-itrt�
City
Zip
State
Lic: #
LICENSED CONTRACTOR'S DECLARATION ..
I hereby affirm that I am licensed under provisions of Chapter g (commencing with Section "
7000) of Diivvisionn of the Business,and Professions Code, and my license is in full force and '
effect. !, l 5
SIGNATURE% - DATE
f 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 to 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 Licanse'+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 'applicant for a permit
' subjects the applicant to a civil penatty'of not more than five hundred dollars'($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will
- 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 or 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 4burden.
of proving that he did not build or improve for the purpose of sale.)
Estimated Valuation
9y /�
S Ls30yA[� 0.O i
PERMIT
-
AMOUNT -
,•
Plan Chk. Dep..
-
Plan CO k. Bal.
Const.nl.3it
Mech.
Electrical
Plumbing
O 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.)
0 1 am exempt under Sec. B. & P.C. for this reason
Grading
Driveway Enc.
Date owner
Infrastructure
22.00
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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
44.50
REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE 4.
(This section need not be completed if the permit is for 'one hundred dollars ($100) valuation
or less.) -
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 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.
ZONE: BY: '
Minimum Setback Distances:
'
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. 3097, Civil Code.)
Side Setback from Property Line
Lender's Name
FINAL DATE
Issued by:
Validated by:
Validation:
A430%
INSPECTOR
Date Permit
2 20 44.50 Sl
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 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`. /
f
Signature of applicant [ 1 F+ f — -_ Date
Mailing Address fr
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. 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 APP./EOUIP.
LAUNDRY TRAY
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 ® 1+/a c
SEWAGE DISPOSAL
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./EOUIP.
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
�t#11NAL INSPECTION 3 6
CERT. OCC.
FENCE FINAL
nar��, i �n a manq i vnwnm � iNw,
GARDEN WALL FINAL