001950 (RER)T4 4.4
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P.O. BOX 1504NO.—
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Building 78-105 CALLE ESTADO
Address 49-1 Art runwX1 LA QUINTA, CALIFORNIA 92253 +
Owner ... :, a
Mailing •
Address
City Zip
95253
Contractor
BUILDING: TYPE,CONST. OCC:.GRP. "
A.P. Number
Tel.
_ Legal Description
Project Description'
Address _..
Uf,* Vii$ 5iS �+"°. .11at 4 _.
City
Zip _ ..: ... • ...
Tel:..
State Lic.
City
& Classif...-
Lic. #
Sq. Ft.
No. No. Dw.
,..
Size ....
ries r
-Stories Units - '
Arch., Engr:; .. .... .... _ .
Designer
New ❑'• Add ❑
Alter ❑•, • ..' Repair ❑ .. Demolition ❑.
Address
TeL
City
Zip Y
State
._...
_�
Lic. #
LICENSED CONTRACTOR'S, DECLARATION .
V
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•BUILDER'DECLARATION "
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for -the following
@• ��e ;
• reason: (Seca 7031.5,Business and Professions Code: Any city or, .county which requfres;'a,... '
"'
• - - '
YQ- "" '
• 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.thal.he is licensed pursuant to
PERMIT.
H ^
-AMOUNT,
' the provisions. of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of _
-
' .'Division 3 of the Busirie'ss and Professions Code, or-that.he'is exempt-tneiefrom, and the basis.
'any
•
Chk..Dep.•
•. •• r
for the . alleged. exemption. Any violation :of Section .7031.5•.by applicant for a. permit'
subjects the applicant to a'civil penalty of not more than five hundred dollars ($500).
:Plan
PIan.Chk. BBI.
_
0,1, as owner of the property, or my employees with wages as theicsole compensation, will
, .,
do the work, and the structure is not intended or offered for sale. (Sec.: 7044, Buisness andK
Const.
0
.. Professions `Code: The' Contractor's License Law does not apply. to an owner of property -who
o .
builds or improves. thereon and who .4. does such work himself or through -his own employees,'
Mech.
'
. provided that such improvements are not intended or offered for said. If, however,' the' building
-
or improvement is sold within one year or completion, the owner -builder will have the burden
EleCtflCal.
_ of proving that he did not build or improve for the purpose W sale.) ..
_• -0'1, as owner of the property, am exclusively contracting with licensed contractors to con-
-Plumbing•
- •• -
struct -the project. (See.. -7044, Busfness•and Professions'Code:• The Contractor's License.Law
• does not apply to an owner or property who builds orFimproves thereon; and who`c ntrcts for
S.M.I.
r
- e' ;•
such projects with a contractor(s) licensed pursuant to he7ContractotT License Law.)le
^
0 1 am exempt. under. Sec. . .. B. VRP for this reason /!
Grading
Driveway Enc.
Date Owner ,�• �. ��r
Infrastructure
WORKERS' COMPENSATION DECL ATION
hereby affirm that I have a certificate of consent to�self4risure, or 'a certificate of
_
Worker's Compensation Insurance, or a certified copy thereof.'(Sec..3800, Labor Code.)
. •
Policy No. Company
..• , E) Copy is filed with the city.,. 0 Certified copy is hereby furnished: _
TOTAL
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' CERTIFICATE OF EXEMPTION FROM
REMARKS
^
_. .. WORKERS' COMPENSATION.INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
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or less.) _ .... _. • , _ .
•
I certify that in the performance of the work for which this'permit is issued, I shall not
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- employ any person in any manner so as to become subjecf.to'the'Workers'Compensation
Laws of California.
Date.. Owner.
NOTICE TO APPLICANT:if, ager making this Certificate of -Exemption you should become �•
-"the'
'ZONE:
:BY' •
' subject' to* the' Workers' Compensation provisions of 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 her affirm that there is'a'conslruction 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
e
Lender's Address
FINAL DATE
INSPECTOR
This is a:building permit when properly filled out,,+signed'and validateid"and is subject to
"
expiration if work thereunder is suspended•forfigo days. J
I certify that.1 have read this applicationfand'state.that .the above`riformation is.correct.
c
Issued by:
Date 12—�Permit
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.
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Signature of
Validated by:
y^
applicant= Date'' .`'
Mailing Address
J
Validation: -
City, State, Zip i !
-
'A'3560
12 1�2 11Z0.0 R
,.
- 4 HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. Q. 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 APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERESS
SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ®c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
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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 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
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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