08767 (RPL)P.O. BOX 1504 r ' .: N o . .0876T,".'
Building 78-105 CALLE ESTADO +
Address 7$-'239 Sain Timoteo LA QUINTA, CALIFORNIA 92253'. -
Owner
Mr. la aal BUILDING:.TYPE CONST.
Mailing OCC: GRP. `
Address qamp. A.P. Number
City. .. Zip Tel.
Legal Description
Contractor— y Project Description
� A• tttnrvl �+ na >� .nes 4°
Address �,�eI AX14 �x �t p[TYBl with F1ete7' pluFtb3 TiQ
City Zip Tel: — —
Cat.city 92234 324-1232
State Lic. -
& Classif.
'Arch., Engr.,
Designer
Address
City
j, LIC
I hereby affirm that I am Ili
• ' ' 7000) of Division 3 of_the Bu
effect. t t1.'!
City
Lic. #�� Sq. Ft. No'. -,f No. Dw
Size - Stories Units _
Tel.
Zip State
Lic. #
CONTRACTOR'S DECLARATION ..
under provisions of Chapter 9 (commenc
and Professions Code, and my license is
New O Add E3,.'-' ',° • Alter ❑ Repair ❑
ion
12d/, I I .
t
< .t
Demoliti6n'
pyy,.•: SIGNATURE
'
OWNER•B?iLOER DECLARATION
I hereby affirm that I am exempt f om the Contractors License Law for the following
Estimated Valuation �3y R!t ja
- BY:
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
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'
permit to construct, alter, improve, demolish, or repair any structure, prior to its' issuance also
Front Setback from Center Line
-
th
requires e applicant for such permit to file a signed statement that he is licensed pursuant to
-PERMIT
-AMOUNT--
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
Division 3 o/ the Business and Professions Code, or that. he is exempt therefrom, and the basis
-
Dep.
work for which this permit is issued. (Sec. 3097, Civilcode.)
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a'permit
Plan Chk.
..:;
subjects the applicant to a civil penalty o/ not more than five hundred dollars ($500).
Bal.
Lender's Address
O I, as owner of the property, or my employees with wages as their sole compensation, will
�•Plan'Chk.
This is a building permit when properly filled out, signed and validated, and is subject to
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
-• Const.
expiration if work thereunder is suspended for 180 days.
_ 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,
Date Permit
�� - ' t.
provided that' such improvements are not intended or offered for sale. If, however, the building
„Mach.' •-�-
.
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 �'
:21.00
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
City, State, Zip
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.)
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-
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_
Grading
0 1 am exempt under Sec. • B. & P.C. for this reason
-
Driveway Enc.
Date Owner
Infrastructure
1
t` 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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. -
h4CERTIFICATE OF EXEPTION FROM
- WORKERS" COMPENSATION INSURANCE. `
(This section need.not be completed if the permit Is for one. hundred dollars ($100) valuation
or less.) . , 5 _ •
I certify that in the performance of the work for.which this permit is issued, I -shall not
employ any person in an manner so as to becomeb' t t th W k ' C
' .. -r••, r>,s+n s be nix G _...+Y::.: tlt4 � 4 .
-51 00 OTAL
TOTAL Sj1. 00
REMARKS 4
Y su
Laws of California. lec o e or ers ompensation
'
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
-subject
ZONE:
- BY:
to the Workers' 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, Civilcode.)
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
5
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 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-.-
bove-.-mentioned
mentioned.property for inspection purposes. _
Validated by:
- -
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. 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
' (/, UNDERGROUND �4AA,4
FLOOR DRAIN
MECHANICAL FEES
COLL. AREA
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
STORAGE TANK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FOUND. REINF
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
SERVICE
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
HOUSE SEWER
_$
LUMBER GR.
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 �4AA,4
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS/ , ��
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF
GAS (ROUGH)
/// METER LOOP
HCl
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
V�
� �
(/
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