003051 (BLCK)-
Twit 44
"
P.O. BOX 1504 NO.. 003051
Building 78-105 CALLE ESTADO
Address 78-585 SAGEBRUSH AVEM LA QUINTA, CALIFORNIA 92253
Mailing
Address 73-585 SAGEBRUSH AV=
City Zip
U Quina. 92253 .
Contractor
OWNER BUILDER
Address
SES
City Zlp
State Lic.
& Classif.. ;
Arch., En -gr.;-
-Designer
BUILDING: TYPE CONST. OCC: GRP..
A.,P.._Number 617 -381 -ON
Tel.
( Legal Description
Project Description Cit�4D.
Tel.. .
City
Lic. #
Sq. Ft. • No. No. Dw.
Size. 160 LMAL IS_'tpries•• Units
New IBX Add ❑ Alter ❑ Repair ❑ 'Demolition ❑• ,
Address
Tel.
City
Zip
State
.
. . .. .
Lic. #
-LICENSED CONTRACTOR'S DECLARATION.. _
I 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
�, •.,� ' Q�
• reason: (Sec., 7031.5,Bu*ness and Professions Code: Any city or county whlch 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 or the Contractor's. License Law, Chapter 9 (commencing with Section 7000) of�.
Division 3 of the Business and Professions Code, or .that: be is exempt therefrom, and the basis
'
for the alleged exemption. Any violation :of Section. 7031.5 by,any applicant for a permit
Plan Chk.De p
subjects the•applicant to a civil penalty of not more than five hundred dollars (5500).*'' . '
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, Bulsness and
COf1St...
Professions Code: The Contractor's License Law does not apply to an ownerof property who
builds or improves thereon
eon 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 of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-,
Plumbing. -
struct the project: (Sec. 7044,• Business and Professions Code:. The Contractor's License Law
. .
does not apply to an owner or property who builds or improves, thereon, and who contracts for
S.M:I." Ir
such projects with a contractor(s)- icensed pursuant to the Contractor's License Law.) -
_
-
Grading
O 1 am exempt under. Sec." . B. & P.C. for this reason
r
Driveway Enc.
.
tt
L1_4�Al t
Infrastructure
Date _4/A:;-0v, ner _- -� r'r
WORKERS' COMPENSATION DECLARATION
' I hereby affirm'that I'have a certificate 'of 'consent to self -insure, or 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 24.00
_
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 thg 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 "Woikers' 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 it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct..
Issued Date 411111 %A7Permit
I agree to comply with all city and county ordinances and state laws relating to building
,by:
construction, and hereby authorize representatives -of this city 4o enter the above
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date
Malling Address
Validation: -
City, State, Zip
67748 4 1-4 2 4.G-0 JI,
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
A.C. UNIT
2N6 FL. SO. FT. ®
SLAB GRADE
YARD SPKLR SYSTEM
POR. SO, FT, ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®
ROUGH WIRING
DRAINAGE PIPING
WALL SO. FT. ®
DUCT WORK
DRINKING FOUNTAIN
SO. FT. ®
GAS (ROUGH)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
REINF. STEEL
GAS (FINAL)
TEMP. POLE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
WATER SYSTEM
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FIRE ZONE ROOFING
SO.FT.GAR ® 3/ac
HOUSE SEWER
FIREPLACE
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 APPJEOUIP.
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
_
DEC
/® fQ c.
• !d
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