003616 (BLCK)P.O. BOX 1504 No. 0 616
BuildingM105 CALLE ESTADO
Address 53-690 Ramirez. LA QUINTA, CALIFORNIA 92253
Mailing
Address e33•, 475 'Beri61t dag
City Zip
La Quina .. 1 92253
Contractor
Pine Creek
Address
Same
.City Zip
State Lic.
& Classif. ..
BUILDING: -TYPE CONST.- OCC: GRP.
A.P..Number 774'®'122"'009J .
Tel. -
544_11096 Legal Description
Project'Description 1501 of '41. high ri taiAirnCi
wall..... ..
Tela
City
Lic. #
Sq. Ft. No. No. Dw.
Size- Stories Units
Arch.; Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
.. ..._
Lic. # .
"_LICENSED CONTRACTOR'S DECLARATION,
V
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Divisimp of the Business and Professions Code, and my license is in full force and" '
effect. f,
SIGNATURE.. % t, DATE
OWN ER'-BUILDCEWDECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for.the following .-
Estimated Valuation
$2#748
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a'
permit fo 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
AMOUNT
the provisions of the Contractor's license Law, Chapter 9 (commencing with Section -7000), of
_PERMIT
Division 3 of'the Business and Professions Code, or. that. tie is exempt'therefrom, and the basis-
for Any Section 7031.5 'any.. for 'permit
Plan Chk. Dep.,
r
- w
the alleged exemption. violation of :by applicant a
' subjects the applicant to a civil penalty of not more than. five hundred dollars ($500).
Plan Chk. Bal..
O 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
Professions Code, The Contractor's License Law does not apply to an owner of property, who -
COnSt.
25%33 T
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.)
.❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
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
S.M.I.
- _-C; .
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
O 1 am exempt under Sec: B. & P.C. for this reason
Driveway Enc.
Dale 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
O Copy is filed with the city.. ❑ 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 ($100) valuation
- -
or less.) "• -
-
certify that in the performance of thg work for which this permit is issued, I shall not
•'
tF11$i; p �,; R!";';Siq rr^-i1 i '-;>'.•Y 1?:
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 thisCertificate of Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you •must forthwith
Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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 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
/
I certify that I have read this application and state that the above information is correct.
"
ISSUed by:
Date / a Permit
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.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. Q. FT.
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
I ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING {ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
_ ��/
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
eL BOND BEAM �7 -
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
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
/
(/,eFOUND. REINF. —
(/
_ ��/
GAS (ROUGH)
METER LOOP'
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
eL BOND BEAM �7 -
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL