002370 (BLCK)Twit.
P.O. BOX 1504
Building 77-575 Wle ro LA QUINOTA, CALIFORNIA92253
Address •
Pate- and laeb—m Lmjt''33'1
Mailing '
Address P.O. ECK 6fif
City Zip Tel.
Xa 32253.
Contractor
... . oWwrlbld"
Address ...
City lzio Tel.
No: 002370
BUILDING: TYPE CONST.- OCC: GRP.
A.P. Number
Legal Description
Project. Description
State Lic.
City
& Classif.
Lic. #
Sq. Ft.No. No. Dw.
*•Stories
Size Units
Arch., Engr.;
Designer
New Qt Add ❑ Alter ❑- Repair ❑ Demolition ❑
Address
Tel.
_
'64,60t high fame'
City
Zip
State
J.
Lic. #
. LICENSED CONTRACTOR'S DECLARATION
y
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•BUILDERDECLARATION
I hereby that I from the Contractor's License Law for following.
Estimated Valuation !!
iL�•��`'
affirm am exempt the
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires -a
�permil-to
..
construct, atter, improve, demolish, or repair any structure, prior to its issuance also"'1
requires the applicant for such -permit-to file a signed statement that he is licensed pursuant to'. -
- 'PERMIT AMOUNT
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 Any, Section 7031.5. by 'any for
Plan Chk. Dep. -
alleged exemption. violation of applicant a permit
"' subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ': "• �'
-
Plan Bal. x 1r •
❑ 1, as owner of the properly, or my employees with wages as their sole compensation, will
,Chk.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
CiOnStx�•�
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,
Mech. '
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.)
- 0 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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) •-
S.M.I. 05U
Grading
O 1 am exempt under Sec. . B. & P.C. for this reason
I f
Driveway Enc.
fe
Date Owner�fi t �-r,=tri
k
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
0. Copy- is filed with the city... ❑ Certified copy is hereby furnished. .
TOTAL • '
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS'COMPENSATIONINSURANCE
(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 anyperson 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
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, Civilcode)
Side Setback from Property Line
Lender's Name
Lender's Address
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:a
SSG
I certify that I have read this application and state that the above information, is correct.
-and
Issued by: Date Tb LPermit
I agree to comply with all city county ordinances and state laws relating to building
construction, and hereby authorize representatives iof this city to enter the above-.
mentioned property for inspection purposes. F
Validated by:
n7
1 7.`~
�?
Signature of applican '' Dale
Mailing Address
Validation:
City, State, Zip f
A5579 5 12 44.22 CK
HARD
COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SO. FT. ®
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. Q. FT. ®
WALL SO. 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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN: EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL .
FURNACE UNIT V%'ALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
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
P,/FOUND. REINF.
f '��REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
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
DEC 17 197
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
m 1Vm" .aiumN1Uncwim111MLQ.
GARDEN WALL FINAL