002935 (RPL)4
P.O. BOX 1504 No. 002935
Building 55-97 t78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
sum-i.se
Mailing •
Address 75
City Zip hh
. . POAM
Contractor
Address
P.O. Em 399
City .. —, , , .. Zip
BUILDING: TYPE CONST. OCC: GRP. -
LX6 Drive A.P. Number
Tel.
..568-2828 Legal Description
Project Description PM VMT2. C
Tela
State Lic.
City
& Classif. 295796
Lic. # 69.
Sq. Ft.
No. No. Dw.
Size
Stories Units
Designer
New q Add ❑ Alter ❑ Repair ❑. Demolition ❑
Address
Tel.
,
City
Zip
State
Lic. #
SIM
_ LICENSED CONTRACTOR'S DECLARATION•. .
hereby affirm that I am,licensed under Provisions ofsChapter 9.(corfmencing with Section
7000) of Division.3 of the'Business an&Professions,Code, and•my license is in full force and
effect. -t �° ., �r j; . � ..a f•'N: - µme ' =fit
v -
SIGNATURE "" DATE
.
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following$.100000.00.
*county
• reason: (Sec. 7031.5,Business and Professions Code: Any city or 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
PERMIT-
- - - 'AMOUNT '
the provisions of the Contractor's License Law, Chapter .9 (commencing with . Section 7000) of
Division3 0l the Business and Professions "Code, or that hers exempt therelmm, and the basis
for the Any Section 7031.5 by 'any for
plan Chk. De p
alleged exemption. violation of applicant a permit.
subjects the applicant to a civil penalty of not more than live hundred' dollars ($500).
Plan Chk. Bal.
22
. ❑ 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
Cpr1St.
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.
6 -00
provided that such improvements are not intended or offered, for sale. If, however, the building
-
ti
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.) .
•
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing-
1� �y
12.40751
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
S.M.I.
'
such projects with a contractor(s) licensed pursuant to the'Contractor's License Law.)
Grading
0 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
' 1 hereby affirm that l have a certificate'of consent to self -insure' ora 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
IS2.P2
CERTIFICATE OF EXEMPTION FROM
REMARKS
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 tho 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 7
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, 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
��� Permit
certify that I have read this application and state that the above information is correct.
Issued by:
Date
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." ^ .4T . � 5
Validated by:
' Signature of applicant/ �'rr Date
Mailing Address v
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. S0. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. 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./EQUIP.
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
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
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