001745 (PLBG)1
P.O. BOX 1504 No. 001745
Building 77-224 C�1B �= LA QUINOTA, CALIFORNIA92253
Address '
Owner I
t BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address -244 CmDa Portv%ny- I A.P. Number 774-2-63-025
CityZip Tel.
la � 92253 64--50'74 Legal Description Lot 13
Contractor Project Description '! feet Of tms line.,.
Address
City Zip Tela. _.
State Lic.
City
& Classif.
Lic. # t
Sq. Ft.
No. No. Dw.
Size
Stories Units
Arch., Engr., . .. .. . .
Designer
New Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel. 1
City
Zip
State
Lic: #
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
4.
effect. f
SIGNATURE DATE
_ .•_ .. _•
• , .. .
' OWNER -BUILDER DECLARATION
Law
Estimated Valuation
hereby affirm that I am exempt from the Contractor's License for the following
•
•, . reason: (Sec. 7031.5,8usiness 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.ficensed pursuant to
. "PERMIT
AMOUNT'
the provisions of the Contractor's License Law, Chapter 9. (commencing 1with Section 7000) of
" Division S of the Business and Professions Code, or'that-he is exempt therefrom,, and the basis
for the Any Section 7031.5 'any for
-Plan Chk..Dep. -
- - -
alleged exemption. violation of by applicant a permit
subjects the applicant to a civil penalty of not more than live hundred dollars ($500):'
Plan Chk. Bal.
-
'
O 1, as owner of the property, or my employees with wages as their sole compensation, will
+COf1St.
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 10 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,i however, the building
Mech. "
- '
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.) 7 ---
1
• O 1, as owner of the property, am exclusively contracting with licensed contractors to coni
Plumbing
n [��a
- - 20.00
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, Iand who contracts for
S. M:
.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
-
- . O I am exempt under Sec. B. 8 P.C.- for this reason
Driveway Enc.
Date ownersZ-'f w`!=:✓�'c.e�'
.._
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to set :insure, ora certificate of '
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company i
.O Copy is filed with the city. O Certified copy is hereby. furnished. ,
TOTAL
20.UU
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100J valuation
' or less.) - j
I certify that in the performance of the work for which this permit is issued, I shall not
employ any pperson 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
'the
ZONE:
BY:
'subject to 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
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 f
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
a4
I certify that I have read this application and state that'the above information is correct.
'county
Issued by:
Date Permit
I*agree to comply with all city and ordinances and state laws relating tc building
,
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for9nspection purposes .%
Validated by:
Signature of applicant! t` 1 �"�1 Date
Mailing Address �� I
Validation:
City, State, Zip I
Y
j
A 2 8 1 5 _
10 81 20.0G CK
..
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SQ. FT. ®
GAR. SQ. FT: ®
CARP. SQ. FT.
WALL SQ. FT. ®
SQ. 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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
ROUGH WIRING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRYTRAY
AIR HANDLING UNIT CFM
GAS (ROUGH)
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
WATER HEATER
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
BOND BEAM
SQ.FT.GAR ® 3/ac
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
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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
' �
'Ore
l
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL