002925 (BLCK)•."tra
44a
P.O. BOX 1504 No. .002925-
BuildingHIM ��=ji�i 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner .. . -.. .. .,.. .. �.. .... ,
• BUILDING: TYPE CONST. OCC: GRP.
Mailing .
Address � A.P. Number
City Zip Tel.
T _ 92253 564-4610Legal Description
Contractors-'
Project Description
N201W. cwner&elei
Address_
-City "
B
Zip _
Tela
State Lic.
City
& Classif.
Lic. #
Sq. Ft.
Size 184 - t.
No. No. Dw.
ft. Stories Units
- Arch:, Engr.� .. .,. .. _
Designer.
.
New.p Add ❑ Alter ❑ .. Repair El -Demolition ❑
f,.
Address
Tel.
_.. ..
City
Zip ..
State
Lic. #.
LICENSED CONTRACTOR'S DECLARATION
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
- I 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
permit•to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires:the applicant /or'such permit to file:a signed, statement that he. is licensed pursuant to
the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 o/ the' Business and Professions Code, or that. he -is. exempt therefrom, 'and 'the basis
for the * alleged exemption. Any violation or Section 7031.5 by any applicant for a permit
... subjects the applicant to a civil penalty o/ not more than /ive.hundred dollars ($500):-
❑ I, as owner of the property, or my employees with wages as their sole compensation; will
Estimated Valuation.
r
-PERMIT -
.
.. -
'AMOUNT
.�
Plan Chk, Dep..
.. - .
Plan Chk. Bal.
- '
Cons.
t1
- 26.
�• do the work, and the structure is not intended or offered for sale. (Sec. 7044; Buisness andv
Professions Code; The Contractor's License Law does not apply to an owner of property who
_.
Mech.
'
builds or improves. thereon and who does such work himself or.. through his own employees, "
• provided that such improvements are not Intended or offered /or sale. If; however, the. building,
' Electrical -
or improvement is sold within one year o/ completion, the owner -builder will have the burden
of proving that. he Cid not build or. improve for the purpose of sale.) ..
Plumbing -
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con •
struct, the project. (Seca 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 /or
...
S.M.I:'
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec: -B. & P.C. for this reason
r '
Grading
-
Driveway Enc.
Date Owner �� ! >` it f' - ' %.-
Infrastructure
WORKERS' COMPENSATION DECLARATION
' I hereby 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
O Copy is filed with the•city... ❑ Certified copy, is hereby furnished.
TOTAL
270.00
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed if the permit is for one hundred dollars ($900) 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: I/, after making this Certificate o/ 'Exemption ; you' should become
' ' . subject 'to the Workers' Compensation' provisions o/ the Labor 'Code, you must. forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY:
Minimum Setback Distances: - -
-
Front Setback from Center Line
'
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
herebyaffirm that there is a construction lending agency for'the performance of the '
-work for which this permit is issued. (Sec. 3097, Civil code.) _ _ -
-
Side StreetSetback.from Center Line -
Side Setback from Property_ Line '
Lender's Name
FINAL DATE.
by:
Validated by:
Validation:
A7315
INSPECTOR
Date Permit
Z 1Z 27.00 C!.
..
Lender's Address
' This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is:correct.ISSUed
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. 1
i t .
Signature of applicant i ! • Date • -i
Mailing Address I.
City,. State, Zip
i
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
S B GRADE
2ND FL. SO. FT. ®
BONDING
YARD SPKLR SYSTEM
FOR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT. ®
OTHER APP./EOUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
BOND BEAM
WATER SYSTEM
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
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR ® 3/ac
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
INSULATION/SOUND
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEEPL.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
S B GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
/ R
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
OUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
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
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
ZFENCE FINAL —�
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL