003288 (BLCK)414
P.O. BOX 1504 No. 003288
Building 78-105 CALLE ESTADO
'Address 52-311 UM LA QUINTA, CALIFORNIA 92253
Owner
:MM M1111M BUILDING: TYPE CONST. OCC: GRP.
'Mailing : .
Address SA14E A.P. Number 773--261-0I5
CityZip Tel.
LA Cii3 `, - 9225 544-34.75 Legal Description
Contractor Project Descriptions 6iCWALL
�/BUIME
Address .......
City Zip Tel... .
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Size - Stories Units -
. Arch., Engr., _. .. - ..
Designer. . 'New ❑ 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 my license is in full force and
effect.
SIGNATURE DATE
OWNER-BUILDER DECLARATION Estimated Valuation
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, after, 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 - AMOUNT K
the provisions o/ the Contractor's License,-Law, Chapter 9 (commencing with Section 7000) of - r
Division 3 of the Business and Professions.'Code, or that.he is'exempt therefrom, and the basis - - for the alleged exemption. Any violation o/ 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..
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const., �•
Professions Code: The Contractor's License Law does not. apply to an owner of property who . - ' •
50
builds or improves thereon and. who does such work-himself or through his own.employees, Mech.
.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 Electrical -
o/ proving.that, he did not build or improve for the purpose of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors.to con Plumbing
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 S. I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)-
0
aw:)-
❑ 1 amexemptunder Sec. B. & P.C.-for this reason Grading
-XI Driveway Enc.
Date �-�} ; owner Infrastructure
WORKERS' COMPENSATION DECLARATION
hereby affirm that' I have a certificate of consent to self-insure; or acertificate 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
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation - `!
I certify that in the performance of the work for which this permit is issued,- I'shall not ?R2126-M V261i ll`._ 1 .39.00
-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 !of 'the Labor Code,- you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
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 theperformance of the. '
work for which this permit is issued. (Sec. 3097, Civil Code.)' i - 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 /q1
expiration if work thereunder is suspended for 180 days. r,/ 61/87 Permit
I certify that I have read this application and state that the above information is correct: . ,; Issued by: Date
'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. Validated by:
Signature.of applicant Date T�
Mailing Address. Validation:
City, State, Zip i
V HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. @ $
2ND FL. SQ. FT. @
POR. SO. FT. @
GAR. SO. FT. @
CAR P. SO. 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
SO. FT. @ c
BATH TUB
BOND BEAM
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR @ 3/4c
HOUSE SEWER
FRAMING
FINAL INSP.
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.IEQUIP.
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
d
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
)I`(&NAL INSPECTION _
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS•
GARDEN WALL FINAL
:d