09252 (PLBG)4'4
P.O. BOX 1504 ; No. 49252
Building 78-105 CALLE ESTADO, ti
Address 54-105 k2 irez LAQUINTA,CALIFORNIA92253.,�y
Owner.,.`��
tt? rR Rarn $ r6 RnipA BUILDING: TYPE CONST..• OCC: GR.P. '
Mailing
Address .Mama.A.P. Number
City Zip Tel.
Fra rm Sa 3 Legal Description
Contractor Project Description
Address.. - Cs�raes"ri_L6 *e
141 McC dds— it Pliace
City lZip Tela
State Lic. City
& Classif. 262578 Lic. # 1892
Arch:, Engr.,
Designer
Address Tel.
,City ( Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION .. -
I hereby affirm fttAQm licensed under provisions of.Chapter 9 (commencing with Section
7000) of Division `of the Business and Professions Code, and my license is in full f rce a/n,d"
effects
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
:;iahe provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
'a,Division 3 o/ the Business 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•toa civil penalty of not more than five hundred dollars ($500).
O 1, 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 •.
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
o/ 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-
struct the project. (Seca 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner o/ 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 exempt under Sec.- B. S P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Work
ierNo an n s ranee, or a certif'e6Therof800, Labor Code:)
iFPolCompany
❑ Copy is filed with the city. ❑ .Certified copy is hereby furnished.
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.)
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. '
• 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.)
Lender's Name
Lender'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.'
1 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 Date
Mailing Address
City, State, Zip
Sq. Ft. No.: No. Dw.
Size Stories Units
New ❑ Add ❑ • Alter ❑ Repair ❑' Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal
Const.
Mech.
Electrical
Plumbing . 30.00
S.M.I.
Grading
Driveway Enc.:
Infrastructure
TOTAL 30.00
REMARKS
ZONE: BY. ._±�8VIM
�A14MINI 1 Ah Aa of
Minimum Setback Distances:
Front Setback:from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side. Setback:.from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
i.:v ;t � t' ""s t '�•- h' -�, �S: ally .. d t >
F.
I. Al .. C.'A !, a -. t•7->'- .� •. _
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT.
DUCT WORK
DRAINAGE PIPING
WALL S0. FT.
GAS (ROUGH)
DRINKING FOUNTAIN.
SO. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL . FLOOR SUSPENDED
GRADING
cu. yd.
$ plus x$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/<c
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
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL