002498 (BLCK)Ru
Building 413,,,,70-1 Sm. SUMS'
Address
P.O. BOX 1504 No,. 002498
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
_ Steve
Mailing
Address 35-250 Wte Palm Dr' . 9 238
City ZipTel.
"athedi 8l CJ r . 9A ►"�.
Contractor
.. . 0=16X%blde'i
Address
City' - -
State Lic.
& Classif.
Arch.; Engr.,
Designer
IZiD " ' ' ITel.
Vlty
Lic. #
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project, Description :.-
X28 - a • Stories
No. Dw.
Units • - - -
Add ❑ Alter ❑ Repair ❑ ' 'Demolition ❑
Address
Tel.
City
Zip
State
:. .. .._ .. .'-
.. _. _ _ ..
- -
-Lic: # •
bic ; $erma
• , LICENSED CONTRACTOR'S DECLARATION
-
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.. ..
SIGNATURE DATE
OWNERaBUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law,for.the following
. - reason: (Sec. 7031.5,Business and. Professions Code: Any city or county, which reputes a '
permit to construct,• alter, improve, emolish, or repair any structure, prior. to its, issuance. also•
requires the applicant for such permit to rile a signed statement that he Js licensed pursuant to'
the provisions of the Contractor's License Law, Chapter 9 (commencing with. Section 7000) o1-
DiWslon 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section. `7031.5 by any applicant for a permit
' _Subjects the applicant to a civil penalty of not more than five hundred dollars (5500). - . •..
❑ I, as owner of the property, or my employees with wages.as their sole compensation, will._
' do the work, and the structure is not intended or offered for sale. (Sec: 7044, Buisness and"
Professions Code: The Contractor's License Law does not apply to an owner of property who
Estimated.Valuation ,
A
200.
- - -
PERMIT ' - AMOUNT
rr -
Pjan.Chk.. Dep. -
N/
Plan. Chk. Bal. - 2rJ.O2 S
CDn$t. - 5�
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'buUding
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.) ,
.M2dh. - - a ,
Electrical
-Plumbing
p I, as owner of.the property, am exclusively contracting with licensed contractors to con-
• strucl the project.. -(Sec. 7044; Business and Professions Code:' The Contractor's License Law
_
S.M•I, • - - - -
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.) -
• O 1 am exempt under Sec: B. li: P.C. for this reason
Grading
Driveway Enc.
Date Owner ��{_� --�
Infrastructure
WORKERS' COMPENSATION DECLARATION
hereby affirm that l 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
- , 0 Copy is•filed with the city. ❑ Certified copy is hereby furnished.: -
TOTAL 64.02
CERTIFICATE OF EXEMPTION FROM
WORKERS'.COMPENSATION INSURANCE S
REMARKS
-
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
- • or less.) •. ... . _
;r I certify that in the performance of tho work for which this permit is issued,' I shall not
-•-- employ -any -=n in any manner so as to become subject to the Workers' Compensation
Laws of California.
-
Date' Owrie'r —'
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 SetbackDistances: '
Front Setback'from Center Line
Rear. Setback from Rear Prop. Line'
CONSTRUCTION LENDING AGENCY_.
Ihereby affirm that there is a construction lending agency for the performance of the
•workfor which this permit is issued. (Sec. 3097, Civil Code.)•
Side Street Setback from Center Line'
-Side Setback, from Property Line '
Lender's Name
Lender's Address
FINAL DATE INSPECTOR
Issued by: Date' i Permit '
Validated by:
Validation:
A 6 0 5 7 7. 28 _. '61,L2 Ch
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: ` •�1�U
I certify that I have read this application and state that the above information incorrect.'•
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. j {f
Signature of applicant Date
Mailing Address
City, State, Zip
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. 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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. @ c
BATH TUB
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
REMARKS:
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 APP.IEQUIP.
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
A IT
N H GRADING'
FINAL INSPECTION
CERT. OCC.
FENCE FINAL.
MbFrciUn a WUNAiUneannIi 1Aw.
GARDEN WALL FINAL