002751 (PLBG)444
r.� P.O. BOX 1504 No. 002751
Building 78-105 CALLE ESTADO
Address 49-035 Wro Circe LA QUINTA, CALIFORNIA 92253
Mailing
Address
City
I
Contractor
M
Address
Zip
id Leaf P1wbb
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Tel.
Legal Description
Project Description
11
CityZip
. -
Tel.
Palm �'
92260
346-6758
State Lic.
City
& Classif.
Lic. # i,
Sq. Ft. No. No. Dw.
!
Size Stories Units
Arch., Engr.,
Designer �
New CF. Add ❑ Alter ❑.' Repair ❑ Demolition ❑
' Address
Tel.
lb irAtall am lim as .oex Ted o1m.
City
Zip
State
_
Lic: #
LICENSED CONTRACTOR'S DECLARATION.
I hereby m
affi that I�am licensed under provisons,of Chapter 9 (commencing with Section
' 7000) of Divi in 3 of the.Business and Professions Code, and my licensetis+in full forc..and
1
f
i effect.AA
SIGNATURE I',\ DATE
I�111i OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby 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'
•0
permit to construct, alter, improve, demolish, or repair any structure, prior.to its issuance also
requires therapplicant for such permit to file a signed statement that-he*is licensed pursuant to
r• -
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 any for
Plan.Chk. Dep. -
alleged exemption. violation of by applicant a permit
subjects the applicant to a civil penalty of not more•than five'hundred dollars ($500). . -
Plan Chk. Bal.
. ❑ 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. �•
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 -
i or improvement is sold within. ve one .year of completion, the owner -builder will have the burden
ol.p/oving that he did norbuild or improfor the purpose of sale.) _
- Electrical
El I; as owner of the property, am exclusively contracting with licensed contractors to con- .
Plumbing 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, and who contracts for
S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
O I 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, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
'
Policy No. Company
3. O Copy is filed with the city. , ❑ Certified copy is hereby furnished.
TOTAL 20.00
' CERTIFICATE OF EXEMPTION FROM
REMARKS-
i WORKERS' COMPENSATION INSURANCE
.
(This section need not be completed it 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
i employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
i Date' Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
ZONE: BY:
subject to the Worker's' 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. (Seo. 3097, Civil code.)
Side Setback from.Property Line
Lender's Name
Lender's Address
FINAL DATE �2, l` �� INSPECTOR �(�G
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 have this
0-4
9 �� 36
1 ii Permit. '
.that.l read 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 aofl'ttiis city to enter the above-
mentioned property for inspection purposets. I k P
�! .t �!- � r 7_,
Validated by:
Signature of applicant ` Date
Mailing Address "
Validation:
City, State, Zip ! 1
A 6 8 8 6 12 10 20. G,0 U
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. ®
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. 0
(ROUGH); 2
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
S (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SQ. FT.
GROUT
WATER HEATER
WALL SO. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
SQ. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® -/ac
HOUSE SEWER
FINISH GRADING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEEPL.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.
(ROUGH); 2
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
S (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 SIGNATURES/INITIALS.
GARDEN WALL FINAL
ROM LEAF
J11
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NO. 1242 - 11 X 17 35016' ISOMETRIC
M C Til
CIL"N OF LA'OUINTA
-community Development/Bldg. Dept.
.,CONniTiONALLY
ACCEPTED F09 CONSTRUCTION
SOBJE(7f TO INSTALLATION AS PER
AND ALL A I PPLX'78#w