002844 (BLCK)f44
Qum&
P.O. BOX 1504 N Q. OJ !.t i d s
Addres
Building �-490 Cai LA QUINOTA, CALIFORNIA 92253
s L �+
Owner
Y=. BraWat=
BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address A.P. Number 517-432-005
City Zip Tel. Lft 27
- La 0iinta .. 92253 Legal Description
Contractor Project Description
iai;i l Y.�%mzwv
Address _
P.O. B= '7$5
City . Zip _ Tel.-
Palms Desert 922161 346--3367'
State Lic. City
& Classif.Lic. # Sq. Ft.' No. No. Dw.
332367 Size Stories Units
Arch., Engr.,
Designer New p Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip.
Tic.#
tate 172 lln. hE 6t 6f 6-fWt h247. b.
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 Profess ions .Code,,and my license is in full force and '
effect. \ 1 yy ..
. --7 r,-, f•!' _ %'• f. -f' i ,✓.ice' :f - • . -
SIGNATURE- .�" '1 - i DATE
Y OWNER -BUILDER DECLARATION ES1lmatetl Valuation
I heretiy 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
♦ 300.00
' 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 thathe is licensed, pursuant to
- ' PERMIT
- AMOUNT
theprovisions 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.Chk..Bal.
fix. s
O 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
Const.
.aV o.iu
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 havethe 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
strucl the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
' improves for
S.M.I.
'.�#V
does not apply to an owner of property who builds or thereon, and who contracts
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ f am exempt under Sec. B. & P.C. for this reason
-
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I' hereby affirm that I have a'certificate of consent to self-insure,,=ot a'certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
lkopy is filed with the city. ❑ Certified copy is hereby furnished.,
,
r
TOTAL�o�
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one' hundred dollars (3100) 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, alter 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: - 1
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
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 certify that I have read this application and slate that the above information is correct.
'and
Issued by:
Date Permit
I agree to comply with all city county ordinances and state laws relating to building
'
construction, and hereby authorize representatives ,of—this ,city 40 enter the above-.
mentioned property for inspection• purposes;
`/ ter"-• /•
Validated by:
Signature of applicant kT `Date' / ..
Mailing Address Ay
Validation:
City, State, Zip i
'
A 7 1 2 8
1 16 83.82 CK.
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. 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,TEMIPERM
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
I�ON'n J �A I
SO.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
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.
INF. EL
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
I�ON'n J �A I
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