002537 (AR)TA•hf
P.O. BOX 1504 No. 00253
78-105 CALLE ESTADO
Address 53--04f3 AW-n0a FwAteft LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE -CONST. • OCC:.GRP.
' Mailing
Address +C
A.P. Number
Legal Description
Project Description
City
m own
Zip
, 92253
Tel.
5 471095
Contractor
_. Address
City
Zip :
Tel. -
State Lic.
City
& Classif.:
Lic..#
Sq. Ft. ,: No. No. Dw.
Size X05 Stories Units
Arch:, Engr.
Designer
New ❑ Add ❑jt Alter ❑ Repair ❑
Demolition ❑
Address
Tel.
City
Zip
State
Lic. # ..
ROM v C.il U-
LICENSED CONTRACTOR'S.DECLARATION • ..
"
hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000)o I Division 3 of the Business and Professions Code, and my license is in full force and
effect...
SIGNATURE DATE
_
OWNER -BUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,4usiness and Professions Code: Any.city or county which requires, a
truct, after, improve, demolish, or repair -any structure;-prior.,to its issuance also
permit'to construct,
requires the applicant for such permit to file a signed statement that he!is,licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or.
" Division. 3 of theBusiness'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 penalty ofhot more than five hundred dollars ($500):
O I, as owner of the properly, 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 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.�:fl3l;
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.) _ -
Estimated Valuation
S 7.,738. 50
-
-
PERMIT
,*
-
AMOUNT
.Plan Chk: Dep. -
- •'
-
Plan Chk. Bal.
44.52
Const*.
i3
-
Mech.
Electrical
_
Plumbing
❑ I, as owner of the properly, am exclusively contracting.with licensed contractors to con-
- struct.lhe project. (Sec. 7044; Business -and Professions Code: The Contractor's License Law
does 'not. apply to an owner or property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - - --
❑ 1 am.exe;pt under Sec. - B. & P.C.-for this reason
Y`" d
_
S.M.I.
Grading
Driveway Enc.
-
%%" o
Date �Ar��Owner
Infrastructure
ERS'
-WOR COMPENSATION DECLARATION
Ihereby affirm that 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
❑ Copy is.filel with the city.. . O Certified copy is hereby furnished.
'' iN k
TOTAL
REMARKS
4 Ill';�CERTIFICATE OF EXEMPTION FROM
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 thg 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.Setbackfrom 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 permit, is issued. (Sec. 3097, Civil Code.)
Side Setback from Property.Llne
'
Lender's Name
FINAL DATE INSPECTOR'
Issued by: Date i?-2tx Permit
Validated by:
Validation: '
A626% 9 2 13555 '4 -1.
Lender's Address
This is a building permit when properly filled out, signed'and validaled,'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 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. ff /'3 ti /�° fJ
Signature of applicants I l�I /.rl (.l jc f/[. ,I Date �r/ ^./� f�
' Mailing Address r �'' ' ' ' �"'"`'' ?"" r% f ••
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. p $
2ND FL. SO. FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT. ®
WALL SO. 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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
SO. FT. ® c
BATH TUB
BOND BEAM
SQ. Ff. p c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.Ff.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
_ '--
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE l . 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 APPJEQUIP.
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
c
_ '--
®� 4�
y4, .
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING17
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL
rod or c-
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_ Coremun� ty Dev lop enfii itl .Dept.
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~ A 34 �k, P xia'
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