001963 (BLCK)P.O. BOX 1504 No, 001963
Building78-105 CALLE ESTADO
Address 49-701 Sal! '.jx:a.a LA QUINTA, CALIFORNIA 92253
Owner _
Mailing
Address
P. �C ���
BUILDING: TYPE CONST. OCC: GRP. '
- y /
A.P. Number e-1) r .
Legal Description
Project Description
City
La Quinta
Zip
92253
Tel.
Contractor
»ter ka>c►c ( t► 3. AlG`.
.6 f: high �'Ti V1aU (m east (frmt) Side
Address
Of yxicipexty cn Yropet Um.
P.O.. P4x 2'010-
' City
Zip
Tel. "
La CAdnta
92253
564-6676
State Lic.
City
& Classif.
Lic. #
Sq. Ft. No. No. Dw.
Size. - Stories" • Units
' Arch., Engr., _
Designer
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
_
Lic. #
LICENSED CONTRACTOR'S DECLARATION
w
I hereby affirm that l 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 forceeland
effect.9 h% 1-
- _ -
SIG_NATD9E' d - DATE
j /p OWNER -BUILDER DECLARATION
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 -
permit to construct, altar, 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
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
- Division 3 of the Business and Profession§ 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).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will
the work, and the structure is not intended or offered for sale. (Sec: 7044, Buisness and
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, •'
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
.of proving that he did not build or improve for the purpose of sale.) --
Estimated Valuation $3s000000
PERMIT - ^ r AMOUNT
'
- -
Plan_Chk. DQp.
Plan Chk' Bal. :2 Z;do
A
CortSt. 38 • 5th
Mech. -
Electrical
Plumbing -
❑ 1, 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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. B. 8 P.C. for this reason .
S.M.I.
Grading
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
O Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL ii.,...
CERTIFICATE OF EXEMPTION FROM
• WORKERS' COMPENSATION INSURANCE
REMARKS
(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_L_Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you -must forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY:
Minimum Setback Distances: "
F.ro.nt Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
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 Street Setback from Center Line
Side Setback from Property Line
Lender's Name
FINAL DATE INSPECTOR
Lender's Address
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.
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. t A rj
Signature of applicant 0', —Date 7 ! j'y
Mailing Address
Issued by: Dat Permit
— —
Validated by: '
Validation:
A 3 6 36 1 2 2 6 6 4. 6 2 Ck
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT.
WALL SQ. FT. ®
SQ. 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.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
PERMIT SVC
PAMPERES
WATER CLOSET
COMPRESSOR HP
MIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
F ISH GRADING
'
INSPECTION
CERT. OCC.
FENCE FINAL
Vn J JIVI•IAI VMMWINI I IAL;:,
GARDEN WALL FINAL