001657 (BLCK)�} :=
P.O. BOX 1504 No. (01657
Building 78'105 CALLE ESTADO
Address 5✓" 650 ft�.a R� LA QUINTA, CALIFORNIA 92253
Owner
r Arruram
Mailing
Address 46-700 P`.ar4lo�+�,g
City Zip Tel.
D~ALM Vb1.0 .9220 1.. 340-6935 .
Contractor
SMIS
Address
Sam
City Zip _ Tel..
sam
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer
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'S `• - DATE
OWNER -BUILDER DECLARATION' Estimated, Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following 750. 00
reason: (Sec. 7031.5,Business and Professions, Coder Any city or county which requires a
BUILDING: TYPE CONST:- • OCC: GRP.
A.P. Number 774-122-008
Legal Description l3't. 17
Project Description
Sq. Ft. 1 No. No. Dw.
Size - Stories - Units•
New Q Add ❑ Alter ❑ Repair ❑
Demolition ❑
permit to construct, alter, improve, demolish, or .repair any structure, prior to its issuance also.
requires the applicant for such permit to rife 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, or that. he is exempt therefrom, and"the� bas is
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 f1ve hundred dollars ($500).
. 0 I, as owner of theproperty, or my employees with wages as their sole compensation, will
-PERMIT
� � � - '• � � '
AMOUNT
Plan Chk. Dep. ..
- -
'
Plan Chk. Bal. .
COf1St.�
•
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 or 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 for sale. If, however, ,the building ,
Electrical
or improvement is sold within one year of completion, the owner -builder willhave the burden
of proving that he did not build or improve for the purpose of.sale.) * - - _. _ ..
Plumbing
-
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
strutt 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. ..
- 1000
- 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.-
Grading
Driveway Enc.
Date Owner
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 "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
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
Side Setback from Property Line
Lender's Name
FINAL DATE
INSPECTOR
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.
I 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. /"
Signature of applicant at`. + / �'' f Date
Mailing Address W r • .> s' -
Issued by-
Validated by:
Validation:
A21%4
.'Date . Pefmit
.8 2
2 U' 0 0 Ck
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
N0. ELECTRICAL FEES
NO. PLUMBING FFEf j ,
1ST FL. SO. FT. Q $
UNITS
SLAB GRADE
2ND FL. SO. FT. ®
BONDING
YARD SPKLH Si STEM
POR. SO. FT, ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT. ®
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER HEATER
SERVICE
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L 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
GAR. FIREWALL
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
MESH
SO.FT.GAR ® 3/ac
HOUSE SEWER
-
INSULATION/SOUND
GAS PIPING
PERMIT FEE
FINISH GRADING
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 6 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.
Tj '+BOND BEAM 01
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.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
f j� ARDEN WALL FINhL _/