002726 (BLCK)Twit autra
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Address 52-940 Averlida lfts��
Owner .
Mailing
Address P.O. Box 580
CityZip Tel.
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Contractor
Aaoress.
City.. Sam Zip Tel.....
State -Li c. City
& Classif.. Lic. #
. Arch.; Engr., '
Designer
P.O. BOX 1504 UU 41 Z 0
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST: OCC: GRP.
A.P. Number
Legal Description
Project Description
Sq. Ft. m� 't..
ri N0.
Size Stories
LNew Add ❑ Alter ❑
-No. Dw.
Units
Repair ❑
Demolition 0
Address
Tel.
r6 � n. feet of 4-. high '41 fr
CityZip
State
Lia # _
:..
_LICENSED CONTRACTOR'S DECLARATION •
hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section.
u
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
A hereby affirm that I am exempt from the Contractor's License Law for the following
7031.5,Business Any
/��q �s aa��
- $. �'..09n.so
reason: (Sec. and Professions Code: .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 rile 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 Professions Code, or'thaL:he is. -exempt: therefrom, and the basis
for the Any Section 7031.5 by *any for
Chk. Dep.
alleged exemption. violation of applicant a. permit
subjects the applicant to -a -civil penalty of not more than five hundred dollars ($500).' . ..-
.-Plan
,-
Plan CFik. Bal. ;
❑ I, 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
Const. �; Yi
. _ 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.
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
of proving that he did not build or. improve for the purpose of sale.). -
' O 1, as owner of the property, am exclusively contracting with licensed contractors to con--
Plumbing
struct the- project. (Sec. -7044, Business and- Professions. Coder 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
❑ I am exempt under.Sec. B. 8 P.C. for this reason
% t
�-
Driveway Enc.
Date �'��'"-'owner ii / _ti•r� .- a.' ��� -a _.F
Infrastructure
WORKERS' COMPENSATION DECLARATION,
hereby affirm that I have a certificate of consent to self•insurb, or A certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
' 'Policy. No. Company
0. Copy is filed with the city., 0 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
or less.) `• - - -
-
certify that in the performance of lhg work for which this'permit is issued; I shall not
tr
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date_L_' Owner
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become
ZONE: BY:
subject' to the Workers" Compensation provisions 'o! the Labor Code, you must forthwith.
comply with such provisions or this permit shall be deemed revoked.
----
.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 lendingagency 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
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 that:the above information is:correct.
+1
Issued by: Date' 1% -20EPermit.
agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives frof this -city to enter the above-.
mentioned property for inspection purposes.
r
Validated by:
//
_ Signature of applicant r ;.r f r ( •Dae
Mailing Address t ""
Validation:
City,.State, Zip
A 6 7 9 8 11 20 31.85 Ck
"
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT. ®
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK `
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT. ®
GAS (ROUGH)
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
WATER SYSTEM
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
C
-
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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 APPJEOUIP.
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.
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FRAMING 1f q /
!Ji
FINAL INSP.
ROOFING
C
-
• 1a7S'
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
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