001777 (PLBG)�r4
P.O. BOX 1504
Building78-104 r � Wn 78 105 CALLS
_Address LA QUINTA, CALIFORNIAORNIA 92253
Owner
Mailing
Address XWOMM P.O. B= 1028
CityZip Tel.
.. Xaa i� 92253
Contractor m C=
Address
68Y-315 KieUT Reo#
City ITel.
No. 0017717
BUILDING: TYPE CONST. 'OCC: GRP.
A.P. Number % T
Legal Description rr
Project Description
State Lic.
& Classif. 256124—A
City
Lic. # ��,�
Sq. Ft. No.
No. Dw.
Front Setback from Center Line
�/
Size Stories • -
Units
-Arch:, Engr.,.
Side Setback from Property Line
Designer
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition ❑
Address
Tel.
Validated by:
Validation:
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION _
' 1 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
r:
effect..•
SIGNATURE A•-" DATE
' OWNER -BUILDER DECLARATION
Estimated Valuation
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
he is licensed to..
PERMIT
- '• AMOUNT
requires the applicant for such permit to file a signed statement that pursuant
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000). of
-
t
• Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
'any for
.Plan Chk. Dep.,-
'
for the alleged exemption. Any violation of Section 7031.5 by applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
Plan- Chk. Bal.
.
❑ 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
i.OnSt.
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,
'Meth.
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
40.00
struct the project. (Sec. .7044, Business and Professions Code: The Contractor's License Law
improves for
M. I.
does not apply to an owner of property who builds or thereon, and who contracts
I such projects with a contractor(s) licensed pursuant to the Contractor's License.Law.)
'--
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent to self -insure, or a certificate of
iWorker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No.' r Company
O 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 tha 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 thele 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.
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.
i
Signature of applicant/ Date ! -� r ""�r•
Mailing Address /
City, State, Zip
HARD COPY
Infrastructure
TOTAL 40.00
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Li-ne
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date= Permit
Validated by:
Validation:
A3092
11 5 40.00 R
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO, FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. S0. FT.
BONDING
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
DUCT WORK
DRAINAGE PIPING
WALL SO. FT.
GAS (ROUGH)
DRINKING FOUNTAIN
SO, FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
REINF. STEEL
WATER PIPING
NOTE: Not to be used as property tax valuation
TEMP. POLE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
WATER SYSTEM
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FIRE ZONE ROOFING
SO.FT.GAR ® 3/ac
HOUSE SEWER
FIREPLACE
GAS PIPING
PERMIT FEE
SPARK ARRESTOR
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 (RCUGH)
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.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
C
n ,
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!
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS,
GARDEN WALL FINAL