05394 (PLBG)T4hf
P.O. BOX 1504 NO. 0` 3 9
Building 78-105 CALLE ESTADO
Address i LA QUINTA, CALIFORNIA 92253
Owner _
Mailing
U BUILDING: TYPECONST. OCC. GRP.
Address
A.P. Number
City Zip Tel.
922 j Legal Description
Contractor 104C L//VE kC-�A1Q-
Project Description
Address
City Zip Tel.
PAS-;-v( 0E562_T 1 1 7:!, 3
State Lic. r� city
& Classif.e _ ! 2 �� �, %�v it Lic. # Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebyy affirm.fhat I am licensed under provisions of Chapter 9 (commencing with Section
7000y of TT}vision 3 of the Business and Professions Code, and my license is in.full force and
effect .
SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm lhal I am exempt from the Contractor's License Law for the foltowing
reason: (Sec. 7031.5.Bushtess and Profcusiens trade: Any city or county whkh requires a
Permd to corrstrucf. after, krgrrove. demWish. or repair any structure, prior to tls issuance also
requires fha appr6 and for such permit to 19a a signed statement that he is 8rensed pursuant to PERMIT AMOUNT
Cher provisions of the Contractor's License Caw, Chapter 9 (commentary with section 7000) of
AW&ron 3 of the Business and Prefesabris Code, or that he is eiternpl therelrom, and the basis
/at Ma alleged exemption. Any viafauon of section 7031.5 by any app5canf for a permit Plan Chk. Dep.
sub)ects the appricanf to a cM penally of not rrfore than five hundred dndars ($500), Plan Chk. Bal.
0 1, 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, Bussness and COr1St.
Professions Cade' The Conitacfoe's License Law does nit apply to an owner of property who
buWs or improves thereon and who does such work himsolf or through his awn anipkiyees. Mech.
provldad that such MeprovemarrN aro m( falerrded or offered for sale- It. howovet, the b"Wing
or improvemenl is sold wilbfn one year of completion, the owner•buMot wN have lire bufdon 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
struct the project. (Sec. 7044, Business and Prolessions Code: The Contracfor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.1.
such projects with a contraclor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec Grading
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, or a certificate of
Worker's Compensation Insurance, or a certified copy theroaf. {Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred do9ars (S100) valuation
or less.)
I certify that in the performance of the 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, N, after making this Cerfirwz!te of Everrpbon you should become ZONE: BY:
suNect to the Workers' Componsaflon pravfslons of the Labor code, you must forthwith Minimum Setback Distances:
comply with such provisions or lho perrMt sha8 be deemed mvakied.
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 N
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 state that the above information is correct. Issued by: Date Permit
I agree to comply with ah 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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, ZIp
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
RO H PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT. @
FORMS
ER OR AROUGH
WIRING
MOBILEHOME SVC.
BAR SINK
POR. gp, FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. I SO. FT. ®
FINAL INSP.
WALL SQ. FT.
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu. yd.
$ plus x$
=$
URINAL
FT ®
FINAL INSP.
FRAMING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/•c
HOUSE SEWER
FINAL INSPECTION
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
RO H PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER OR AROUGH
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL