003601 (SFD)Building
Address
Owner
Mailing
Address
City
Palm I
Contractor
Address
State Lic.
& Classif.- • 450429
Arch.- Engr.,
Designer
C&ty" 4 4..Q ".
ntae.�r s1�9 vrn
Zip
I Lic. #
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P.O. BOX 1504 NU. UUJbU1
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST: OCC: GRP.
A.P. Number
- lLegal Description
Project Description sinale Family P3'ellinq
Sq. Ft. No. No. Dw.
Size to ' Units
New ❑ Add ❑ Alter ❑ Repair ❑
Address Tel.
41--A f-AJima
City Zip State
.. - Lic. #
LICENSED CONTRACTOR'S DECLARATIONS `
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
I hereby affirm that I am exempt from the Contractor's License Law for the following.
reason: (Sec. ?03 1..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 rile a signed statement that'he is licensed pursuant -to
Estimated .V81UatlOn
'
-
PERMIT.
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
'
'
Plan Chk.. Dep. ,
Division 3 of the Business and Professions Code, or that. he Is'exempt therefrom, and the' basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
-' 'subjects the applicant to a civil penalty of'not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Bal..
COf1St.
do the work, and the structure is not intended or offered for site. (Sec. 7044,'Buisness and
Professions Code: The Contractor's License Law does not apply to an ownerof property.who
Mech. '
builds or improves thereon and who does such work himself, or through his own employees,
provided that' such improvements are not intended or offered for sale. If, however, the building
Electrical
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.) '
Plumbing
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
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.) -
O 1 am exempt under Sec. B. & P.C. for this reason
•
Grading
`Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
CONSTRUCTION LENDING AGENCY
I hereby affirm 'that I have a certificate of'consent to self -insure, or A certificate of
Side Street Setback ffom.Center Line
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
_qA_nQ
Policy No. Company
❑ Copy is filed with the city. 0 Certified.copy is hereby furnished.
AA 17
TOTAL
Side Setback from Property Line
-CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed if the permit is for one hundred dollars ($100) • valuation
Demolition ❑
.Rai
_ -
AMOUNT
Laws of California
Date Owner '—
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
%ter _ wit fr'"''•
BY:
i n ii
Minimum Setback
Distances:
comply with such provisions or this permit shall be deemed revoked.
?n -nn t.
Front Setback from Center Line
Rear Setback from. Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback ffom.Center Line
tir r�
_qA_nQ
-
work for which this permit is issued. (Sec. 3097, Civil Code.)
Side Setback from Property Line
Lender's Name
or less.)
certify that in the.performance of tha work for which this permit is issued, I shall not
_ -
employ any person in any manner so as to become subject to the Workers' Compensatiori
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 provisions 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 ffom.Center Line
• 1 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 if work thereunder is suspended for 180 days:
{ y
8
I certify that I have read this.application and state that the above information is correct.
Issued by:
A Permit
- Date ! J
1 agree to comply with all'city and county ordinances and state laws relating to building
4
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
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE ('6
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
-.
NO EWER OR SE
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
S (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
WALL SQ. Ff.
FINAL INSP.
DRINKING FOUNTAIN
SQ. FT.®.
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FRAMING V
FLOOR DRAIN
MECHANICAL FEES
��yy
of
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
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
MESH
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
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 PLUMBI I�
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE ('6
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
-.
NO EWER OR SE
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REI NF. 3 �,b ®�
/
S (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
O
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING V
FINAL INSP.
%
ROOFING 1
��yy
of
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR.: FIREWALL
LATHING ON
MESH
16INSULATION/SOUND q
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL