002093 (RR)44
P.O. BOX 1504 NQ. 002093
Building78-105 CALLE ESTADO
Address 54"881 bra romi= LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. OCC: GRP.'
Mailing - .. - ~-� � ;._#
Address A.P. Number i 1 rl4 C �-�> t
City Zip Tel.
. . . I - .x off: 3 .9
Contractor 7�,�
A H fi r 'TLWa
Address. . .
r220 vimiral Few
City ... .. .Zip . .. Tel.. ..
Pa
tv
State Lic. City
& Classif:& Lic. #
Arch., Engr., ;
-Designer .
Address Tel.
City Zip State
Lic: #
LICENSED CONTRACTOR'S. DECLARATION.
I hereby affirm that I aA licensed under provisions of Chapter 9 (commencing with :Section'
7000) of Division 3 o the/,Business and Professions Code, and my license is' in full force and -
effect.. ?FyiJ P_
SIGNATURE B+ ' d o b 6 l..,z DATE
x %' 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, 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 to'acivil penalty of not more than.five'hundred dollars ($500): . .. -
❑ I, as owner of the property, or my employees with wages as their sole compensation, will .
Legal Description
Project. Description
Sq. Ft.
Size
New ❑
No. No. Dw.
Stories Units
Add E3 Alter 0 Repair Ek -Demolition ❑
s.< . t M. -MR -l-,
Estimated Valuation
PERMIT r -
Plan Chk: Dep.
Plan Chk. Bal.
AMOUNT
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
COnSt.
Professions Code: The Contractor's License Law does 'not apply to an owner of property who
ARAin
_
builds or improves thereon and who does such work himself or through his own employees,'
'Meeh.
provided that such improvements are.not intended or offered for sale: If, however, the building
or improvemehl 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 o/ 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.
.. 44''
. such projects. with a-contractor(s) licensed pursuant to the Contractor's License Law.) - -
Grading
O I am exempt under Sea B. 8 P.C. for this reason . .
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
1 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
•��'"j
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.)
I 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: If, after making this Certificate of Exemption you should become
ZONE:
BY: '
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
.
Minimum Setback Distances: -
'
Front Setback from Center Line
Rear Setback from -Rear Prop. Line
. colusrRucrtoN LENDING AGENCY .
Side Street. Setback from Center Line'
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
' This is a building permit when properly filled out, signed and validated, and is subject to
FINAL DATE
INSPECTOR
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:
'city
"ISSUed by:
Date����'"�- Permit
I agree to comply with all and county ordinances and state laws relating to building
construction, and hereby, authorize, representatives -of this city to enter the above.
mentioned property for inspectionrfpurpkssessy/
/ l
Validated by: '
Signature of applicant %r'. /7 '.✓ '- �� --»_.. —•.Date
Mailing Address f '7—
Validation:
City, State, Zip
_ A4.449
2. Z7 3910G'-il
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT. ®
FOR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT. ®
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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./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
INSULATIONISOUND
FINISH GRADING
/AL INSPECTION S
CERT. OCC.
FENCE FINAL
INb Vr%;I UM"J SIUNA 1 UNrblIN I I IALJ
GARDEN WALL FINAL