10587 (AR)TitT 4
a - P.O. BOX 1504 NO. 10587
Building 78-105 CALLE ESTADO
Address 48m43t3I .San Pedro LA QUINTA, CALIFORNIA 92253 J
Owner
Jim i14h 4r.11a}l! BUILDING: TYPE CONST. (( OCC: GRP.
Mailing I
Address
A.P. Number.
CityZip Tel.
La oni-nta 92253 Legal Description
Contractor Project Description
71 _ KPnnPdV (_n n11 -r +e --'t $ n
Address ROOM ADDITION
7 7 3 543 .Ar 10oba ,
City Zip Tel.:
La Ouinta 92,253 564®4660
State L'ic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr.,°
442118 X69 Size 2f93 Stories Units
•
Designer New ❑ 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 ,
(• e000)t f Division 3 of the Business and Professions Code, and my license is in full force and
r J
'—SIGNATURErAT
DE _
Y OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation 454.50
C
reason:.4.5
(Sec. 7031.5, Business -and Professions Code: Any city or county which requires a 14 • 4 • 5Q
permit to construct, atter, Improve, demolish, or repair any, structure, 'prior toitsIssuance also
�requlres the applicant for such permit to.file a signed statement that he is licensed pursuant to PERMIT AMOUNT
• a ; . -
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 exempt therefrom, and the basis •- -
for the alleged exemption. Any. violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects the applicant to a civilpenalty of not'more than five hundred dollars.($500).- '
O I, as owner of the property, or my employees with wages as their sole compensation, will • ' Plan Chk. Bal. A i on
do the work, and the structure is not Intended or offered for sale. (Sec. 7044, Buisness and CiOnSt.
Professions Code: The Contractor's license Law does not apply to an owner of property who A 26 -
builds
Ei builds or improves thereon and who does such workhimselfor through his own employees; Mech. 5
provided that such improvements are not intended or offered for sale. If, however,. . the building 1 '
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.)
b, 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 of property who builds or improves thereon, and who.contracts for S.M.I. - 'i` in
•- such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - -
Grading
O 1 am exempt under Sec. - B. & P.C. for this reason
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, ora certified. copy.thereof...(Sec. 3800, Labor Code.)
Policy No. Company
` "S E�Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL '209.00. U t
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.) -
certify that in the performance of thg work for which this permit is issued, -1 shall not
employ any person in any manner so as to become subject to the Workers" Com pensat ion �1�a nY .. x . _. „t a v
Laws of California. f( '- t gi.:H T TOTAL 209a4�
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 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 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 t' 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
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO, 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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
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.
SO. FT. ®c
1BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.J.
SO. FT. RESID ® IV4 c
SEWAGE DISPOSAL
U •I /A /QL
SO.FT.GAR ® 3/sc
HOUSE SEWER
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 o"' PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADEVY
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 a
FINAL INSP.
ROOFING
U •I /A /QL
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GEAR. FIREWALL
pHING
MESH
INSULATIONISOUND 34
FINISH GRADING
FINAL INSPECTION-
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL