003669 (BLCK)P.O. BOX 1504 NO.
Building r- nom.. y31 78-105 CALLE ESTADO
Address 51 Ave. rlamirez LA QUINTA, CALIFORNIA 92253
Owner
11. Miller '. BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address saw A.P. Number 773-262-008
City Zip Tel.
Lot- 01ttin 564-3475 Legal Description
Contractor Project Description 6 hiazh block X7..11 10101
Address... . .. C►]Iic!
City-. Izip. Tel.... _
State Lic. City
& Classif.. Lic. # Sq. Ft.. No. No. Dw.
Size Stories Units
Arch., Engr:;
Designer New ❑ Add ❑ Alter ❑' Repair ❑ Demolition -0
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
1 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' 9
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
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Piofessions 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 Plan Chk..Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars (S500). " �` • . "
O 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, d7,3,,� e+ A 5
Professions Code: The Contractor's License Law does not apply to an owner of, property who CbnSt•
builds or improves thereon and who does such work himself or throughhisown employees,
provided that such improvements are not intended or offered.for sale. If, however, the building Mech. of improvement is sold within one year of completion, the owner -builder will have the burden Electrical -
of proving that he did not build or improve forthe purpose of sale.) e
O 1, 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.M.I.' -
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - -
Grading
O I am exempt under Sec.. - B. 8 P.C. for this reason -
Driveway Enc.
Date `-1 Z Owner �./ f / • . 'r`fr Infrastructure
WORKERS' COMPENSATION DECLARATION
hereby affirm that I' have a certificate of consent to'self•insure, ora 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... O.Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS' " Y W -
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation n;e �•.e 1ek.•� ; y ;n7.,.,r,.y ,.ar4. r,r.y F'�A: ,� .,,
or less:)
• I certify that in the performance of thg work for which this permit is issued,'I shall not -• its k.?$? •. vist•i:C- ! -•.},!}O'"`
-- -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 AGENCYSide Street Setback from Center Line
Vhereby 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 -
Lender's Address
This is a building permit When properly filled out, signed'and validated,' and is subject to - .FINAL DATE - : INSPECTOR
expiration if work thereunder is suspended for 180 days. t
I certify'that I have read this application and state that the above information is correct.. Issued by: 'Date 2 ` 29 8fiPermit
agree to comply with all city and county ordinances acid state laws relating. to building
construction, and hereby authorize representatives of this city 4o enter the above-.
mentioned property for inspection purposes. Validated. by:
Signature of applicant Date
Mailing Address _ Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT. ®
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®
DUCT WORK
DRAINAGE PIPING
WALL SO. FT. ®
DRINKING FOUNTAIN
SO. 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
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
FIREPLACE
SQ. 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
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
SEWER OR SEPTIC TANK
_ ROUGH WIRING
DUCT WORK
ROCK STORAGE
/FORMS
/�rOLIND. REINF.
GAS (ROUGH)
METER LOOP .
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM 3
TER 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
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL