001575 (BLCK)P.O. BOX 1504 No.. 0 1575
Buildingr a 78-105 CALLE ESTADO
Address 53-365 PS -26i& P%-= LA QUINTA, CALIFORNIA 92253
exiu v >. XAZ
BUILDING- TYPE CONST. OCC: GRP.
Mailing
Address sam
A.P. Number
City
Zip
Tel.
Ta 'Quint1'
�64747
Legal Description
Project Description
Contractor
LechlpAtk= Fer .
Address
TOW; T.i $ip AVA.
City�. Zip .. ��--��gg
mi-ra � 91-75 L
State Lic.
City
& Classif. Zvsio
Lic. #
Sq. Ft. 11� i
Size
£t No. No. Dw.
'Stories . Units
Arch.,'Erigr., .. ._ . .. ..
Designer
New;p 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
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, alter, 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
the provisions of the Contractor's License Law, Chapter.9 (commencing. with Section 7000) of
' Division 3,of the Business and Professions Code, of 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 of not more than five hundred dollars (8500):
., ❑ 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, Buisnessand
Professions Code: The Contractor's License Law does not apply to an owner of property. who
Estimated Valuation
�
�.' 900Q�. 00
- PERMIT
;-
- AMOUNT
Plan Chk.D'ep..
-
Plan Chk. Bal.
Const.
®:�i..!•
'Mach.
'
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
• 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.) .
Electrical -
Plumbing
..
-
• ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
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
such -projects with a contractor(s) licensed pursuant to the Contractor's License Law.) • _.
❑ I am exempt .under Sec: B. 8 P.C. for this reason
S.M.I:
•' -
Grading
Driveway Enc.
Date owne ,r i •> y"r - (~ A' (6r'
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
❑ Copy is filed with.the city. - ❑ Certified copy is hereby. furnished.
TOTAL
20.00
CERTIFICATE OF EXEMPTION FROM
WORKERS' .COMPENSATION. INSURANCE
REMARKS
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the 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 mustshould_
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..
I 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 Street Setback from. Center Line
$Ida Setback from Property Line '
Lender's Name
Lend'er's Address
' 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. '
FINAL DATE
INSPECTOR -
I certify .that I have read this application and state that the above information is correct.
.I agree to comply with all city and county ordinances and state laws 'relating 4o building
construction, and hereby authorize representatives -of this "city to enter the 'above
mentioned property for inspection purposes.# _ r
r , f : �i�6�
lica
Signature of appnt *-.._l r a+ F i.. Date
Mailing Address— s ° !'�•• r
Issued by: -
V alidated by
Validation:
A 1 6 0 9
Date Permit
6 1 8 2'R•'0 G CK
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
UNITS
A.C. UNIT
2ND FL. SO. FT. @
SLAB GRADE
YARD SPKLR SYSTEM
POR. SQ. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. @
DRAINAGE PIPING
WALL SQ. FT. @
DUCT WORK
DRINKING FOUNTAIN
SQ. FT. @
GAS (ROUGH)
URINAL
ESTIMATED CONSTRUCTION VALUATION
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
WATER PIPING
NOTE: Not to be used as property tax valuation
EMP. POLE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
LUMBER GR.
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
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)
EMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
b <C `ib
c � PIA 3,��7 Gtr
DEC 17
_
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE. FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL