001581 (BLCK)Building
Address
Owner
Mailing
Address
City
-
Contractor
Address
Zip
P.O. BOX 1504 No.'�,
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253 +
, ckwwd BUILDING: TYPE CONST. OCC: GRP.,
nida velasm A.P..Number
Ted.
fi —927A Legal Description
Project Description iM ft.4 it
s'6
City.... Zip Tel.
airZG`,t'!'
State Lic. City
& Classif.: Lic. # Sq. Ft., No. No. Dw.
• Size - Stories Units
-Arch-, Engr. .
Designer New EJ Add ❑ Alter ❑ Repair ❑ Demolition.❑ -
Address Tel.
City Zip State
Lic. # -.
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section +
7000) of Division 3 of the Business and. Professions Code, and mylicense is in full force and '•-
effect.
v..n`n•o"""`� "`y`�"�"V� Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following 5f
permit
reason: ,(Sec. 7031.5,Business and Professions Code: Any city or.county which- requires a 'Y 4A5k
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 - PERMIT
the provisions of the Contractor's License Law, .Chapter 9 (commencing with Section 7000) of
Division 3 or theBusiness and Professions Code, or that -he -is exempt therefrom, and the basis
for thealleged 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.
Plan Chk. Bal.
❑ I, as owner of. the property, or my employees with wages as their solecompensation, 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 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.)-
❑ 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 contractor(s) licensed pursuant to the Contractor's License Law.) .. -
❑ I am exempt under Sec. B. 8 P.C. for this reason -
s
Cor1St. '
Mech. .
Electrical '
Plumbing '
S.M.L -
Grading
Driveway Enc.
Date Owner �`-� := • �" ,�3 �~ ` : M �+ �'
Infrastructure;,
WORKERS' COMPENSATION DECLARATION
hereby affirm wthat 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:. .
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
Th'
ZONE: BY:
subject to 'the Workers' Compensation provisions or the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
acsnces: ' -
Minimum Setback Distances:
TOTAL
REMARKS
Rear Setback from Rear Prop. Line
G.W
tP AMOUNT '
32.8
r 50.511
( is sect need not be completed d the permit is dor one hundred dollars ($100) valuation
or less.) •.. - .. .. ...
certify that in the performance of the work for which this permitis 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
ZONE: BY:
subject to 'the Workers' Compensation provisions or the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
acsnces: ' -
Minimum Setback Distances:
Front Setback from.Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
hereby affirm that there is a construction lending agency for the performance. of the -
work for which this. per is issued. (Sec. 3097, Civil Code.) ..
Side Setback. from Property Line
Lender's Name
Lender's Address
FINAL DATE INSPECTOR
' . 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'lhat'the above information is correct:'
'• Issued by.- Date ''"'"" Permit
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
�i
../:.
Validated by:
Signature of applicantr
�
Mailing Address !
Validation:
City, State, Zip
A 1. 7_1.4 .. .b . 2 4_. 8 .8. 2. CK _ ..
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT. ®
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ, FT, ®
POWER OUTLET
I ROOF DRAINS
CAR P. SQ. FT. ®
DUCT WORK
DRAINAGE PIPING
WALL SO. FT. ®
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
Q
v
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
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.
SQ. FT. ® c
BATH TUB
FIREPLACE
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
MESH
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
l OUND. REINF.
��' "`
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
/
OND BEAM /
bbb
Q
v
WATER SYSTEM
GRADING
cu. yd.
$ —Plus—X$—=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING'
t
/
..
REMARKS:
VENTILATION
r
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
Ji
GAR. FIREWALL J
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
�-kNAL INSPECTION /
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL