002423 (BLCK)P.O. BOX 1504 No. 002423
Building 78-105 CALLE ESTADO
Address 46-1110 n ix T—mil l LA QUINTA, CALIFORNIA 92253
Owner
Mailing
BUILDING: TYPE CONST.- . OCC: GRP.
� / 1
Address , A.P. Number
CityZip Tel.
Legal Description A. h /
Contractor Project Description
DCC
Address 50 Wt Of 3—biYlock
74-w— % .. An 40 f�'�'-t of f-fwt hinh blook Waal
City Zip Tela m
B; Italia Dunes 92MI 345-4161
State Lic. City
& Classif._ , 3pi?31� Lic. # � Sq. Ft. go � f'No. No. Dw.
Size Stories Units
.Arch., Engr:;
Designer New OX Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
. Lic. #.
_ LICENSED CONTRACTOR'S DECLARATION, _ ^
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'antl
effect.. V -1 �`' /.
SIGNATURW 1"� :'1.. DATE '
. OWNER4UILDER DECLARATION Estimated Valuation 9� y�
I hereby affirm that I am exempt from the Contractor's License Law for the following .1 750.
reason: (Sec. 7031.5,Business and Professions Code: Any city or. county 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
Division 3 of the' Business and Professions' Code,. or. that. he is eiempt therefrom, and the basis • • - - - for the alleged exemption. Any violation of Section 7031.5 by 'any applicant .for •a permitD
' Plan Chk.• ep.
subjects the applicant to a civil penalty otnot more than five'hundred dollars ($500). " -
❑ 1, as owner of the property, or my employees with wages as their•sole compensation, will Plan Chk. Bal. 14.17�
do the work, and the structure is not intended or offered for sale. jSee. 7044, Buisness and Const.N
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 have the burden Electrical -
of proving that he did not build or improve for the purpose or sale.) _ '
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing - -
struct the project. (Sec. 704.4, 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.l. • such projects with a contractor(s) licensed pursuant to the Contractor's License Law)
Grading
❑ 1 am exempt under Sec.- B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
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
O Copy is filed with the city. • ❑ Certified copy is hereby furnished.
TOTAL 49.17
CERTIFICATE OF EXEMPTION FROM REMARKS,
_... WORKERS' COMPENSATIOWINSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.).. _ _ _
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: If, after making this Certificate of Exemption you should become ZONE: BY:
subject 'to 'the Workers' Compensation provision's of the Labor Code, you must:forthwith Minimum Setback Distances:'
comply with such provisions or this permit shall be deemed revoked.
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
This is'a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
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' 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. Validated by:
Signature of applicant ��•� Date
Mailing Address Validation:
City, State, Zip
A5834 6 18 49,17 CK
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. p $
UNITS
A.C. UNIT
2ND FL. SQ. FT. ®
SLAB GRADE
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®
ROUGH WIRING
DRAINAGE PIPING
WALL SQ. FT. ®
DUCT WORK
DRINKING FOUNTAIN
SO. FT. ®
GAS (ROUGH)
URINAL
'ESTIMATED CONSTRUCTION VALUATION $
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
WATER PIPING
SNOT E: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
SERVICE
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
LUMBER GR.
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/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
SPARK ARRESTOR
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.
A1,00ND 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
INSPEU TUN'S SIUNA 1 UHL511N1 t 1ALS,
GARDEN WALL FINAL