003614 (AR)P.O. BOX 1504 No. 001361 4
Building 78-105 CALLE ESTADO
Address 51-5503 MRMWX5 LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST.
� V OCC. GRP. 1
Mailing
Address BOX 438
A.P. Number
Legal Description
Project Description
773-145-014
51-503 ADUTDA aBF.3WOVS,r Lir QOZ:iA
ADDI?ZOh " PHASE I
CityL& QUIMA
zip 92253.
Tel.
Contractor
Address
City ]Zip
Tel.
+ State Lic.
City
& Classif.
Lic. #
Sq. Ft.
Size 169
No. No. Dw.
Stories I Units
Arch., Engr.,-
Designer JOHN It. IIM
New ❑ Add Q7, Alter 0 Repair ❑ Demolition ❑
Address
Tel.
P.O.. BOX 1575
564-3363-
64-3363_City
506 F' OF 1'f}P.M INCLUDED IN THIS PM— MIT
City
LA QUDITA
Zip
92253
State
Lic. # C13625
" 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, 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 a civil penalty o/ not more than five hundred dollars ($500). —
. ❑ I, as owner of the properly, 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 o/ property who
'builds or improves thereon and who does such work himself or through his own employees,
that such Improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year o/ completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
Estimated Valuation
$� ��4
s
I r-., '
— '• PERMIT
- AMOUNT
. plan Chk: De
p
Plan Chk. Bal.
67.92
'Const.
�L
194.50
Mech.
.10.00provided
Electrical
14"' a 23
_
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 o/ property who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
O l am exempt under Sec. B. & P.C. for this reason
S.M.I.
_
- '
Grading
Driveway Enc.
/Date_j* �"rt'-Downer f r ' / T '%7 —
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
J
REMARKS
CERTIFICATE OF EXEMPTION FROM
' WORKERS' COMPENSATION INSURANCE
-
(This section need not be completed it the permit is /or one hundred dollars ($100) valuation
or less.)i;lT71T1
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.
f tV Ci()b:. 'J. U } c'u + t
4 A 0L1 VI4 i 1 O 1'Al t 2''! 1. t. ,
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate o/ 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
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
j Lenders 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.
i I certify that 1 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.
FINAL DATEINSPECTOR
Issued by;
Validated by:
Date Permit
Signature'of applicant Date
Mailing Address "
Validation:
City, State, Zip
L
HARD COPY
-
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. @ $
UNITS
COLL. AREA
2ND FL. SQ. FT. ®
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. @
DUCT WORK
DRAINAGE PIPING
WALL SQ. 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
yd.
$ plus x$
LAUNDRYTRAY
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.
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
SPARK ARRESTOR
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./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.cu.
FRAMING Lt � si��
FINAL INSP.
OOFING318 '—�fe—
/�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING S
MESH
INSULATIONISOUND 3
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL 7d