002854 (RR)'Building
Address
Owner
P.O. BOX 1504 Na.
' .. Ll -
78-105 CALLE ESTADO ,
2854
LA QUINTA, CALIFORNIA 92253.
cess nigh,
Address 9327 DWP 1v*916y
City Zip Tel.
. Wiling i AWS
Contractor
- Zip ._ Tel.....
92201
BUILDING: TYPE CONST. • OCC: GRP; `
' r
A.P. Number
Legal. Description
Project Description
=f .
State Lic.
City
& Classif.• "4421'
Lic. #
Sq. Ft.
No. No. Dw.
. Arch.; -En r., .. .. .. .. ,...
Size- - '•
Stories Units.- ..
Designer
New q Add ❑
Alter .0 Repair ❑ Demolition ❑ •-
Address
Tel.
....
City
ZipState
Lic. #.
. .
. 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:, # ✓.`�--•-•"'
,_ �R G ,. ce S' /r rvf�1 - /� ..�-t�"^.R- , .. .. : gyp, J -,�� . •
SIGNATURE " f DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
p
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6 '
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reason: (Sec. 7031.5,Business and Professions Code: Any•city•or, county which requires..,a
perinif to construct, after, Improve, demolish, or repair - any' structure, prior to its issuance. also.
- -
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requires the 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
' Division 3 of the Business and Professions Code, or that..he is exempt. therefrom, and'the'basis
for the 'Any Section 7031.5 'any
Plan.Chk: Dep.,
- -
alleged exemption. violation of by applicant for a permit
' subjects the -applicant to a civil penalty of not more than five hundred dollars' ($500).
O 1, the
-Plan Chk. Bala,
-
as owner of property, or my employees with wages as their sole compensation, will
do thework, and the structure is not intended or offered for sale. (Seca 7044, Buisness and
_
. Professions Code: The Contractor's License Law does not apply to an owner of property who
'
COf1St.. -i:,
cn
au
- builds or improves thereon and who does such work himself or through his own employees,
Mech' • -
'
. ,provided that such improvements are not intended or offered for sale. If, however, the building
.
- -
ar of completion,. the. owner -builder will have the. burden=•
or improvement is sold within one year
Electricals
•' '- -
. of proving that he did not build or improve for the purpose of sale.) .. , ,
_
,
❑ 1, 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 or 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.) -
Grading
, . O lam exempt under Sec. B. ti• P.C. for this reason
Driveway Enc.
Date ' Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent4o self -insure, or a certificate of
_
Worker's Compensation Insurance, ora certified copy thereof: (Seca 3800, Labor Code.)
- -
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Policy NO.' .Company
O Copy is filed with the city.. ❑.Certified copy is hereby furnished.. ,..
TOTAL
'10' AO '
CERTIFICATE OF EXEMPTION FROM "
REMARKS
WORKERS' COMPENSATIONINSURANCE . -
• (This section need not be completed if the permit is for one hundred 'dollars ($100) valuation
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orless.) .. __. .. ..
_
I certify that in the performance of the 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
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• ZONE:
BY:
subject to the' Workers' Compensation provisions 'of tne' LaborCode,•• you 'must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum 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, 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.
' 'county
Issued by:
y-- �
Date permit
I agree to comply with all city and ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to -enter the above:.
mentioned property for inspectionpurposes. t
Validated by:
Signature of applicant '7 frr.. a �.� Date -F
Mailing Address__~_Validation:
_
City, State, Zip t
A%169
1 2'6 9.•G0 U
HARDCOPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES .
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT. ®'
WALL SO. 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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROUGH WIRING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRYTRAY
AIR HANDLING UNIT CFM
I
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
WATER HEATER
SQ. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
BOND BEAM
SQ.FT.GAR ® 3/ac
HOUSE SEWER
$
GRADING
cu. yd.
plus x$
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
C
®�C
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