05408 (RPL)Building
Address
Li
Owner
Mailing
Plan Chk. Bal.
Address j f
t, Pa i f •�
cityCttmrtJ>ri
Zip
i-) a &,
Electrical
Contractor
Plumbing
Address
c&t!t 4 4
"
P.O. BOX 1504 No. 05408
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST.OCC: GRP.
` A.P. Number k:s 7
Tel.
Legal Description
Project Description �' +� -J
State Lic. I City
8r Classif. % Lic. #
Arch., Engr.,
Designer
Address I Tel.
uty IZip I State
C. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm Mat 1 am licensed under provisions of Chapter 9 (commencing with Section
7000) of on 3 of the Business and Professions Code, and my license is in full force and
effect
SIGNATURE DATE
OwNEA-BUILDER DECLARATION
1 hereby affirin that 1 am exempt from the Contractor's License Law for the following
reasons (Sec. 7031-5,9sfness and Rdessions lode: Any city or county which requires a
Dern* to construct, ater, hrprove, demofish, or repair any structure, prior to its issuance also
requires the alptirad for such petm7 to tie a signed statement that he is licensed pursuant to
the provLs+orrs d the Contractors License taw, Chapter 9 (commencing with Section 7000) of
avIslon 3 of the Bushess and gafessions Code, or that. he is exempt therefrom, and the basis
for the MMOd exenpftL Any violation of Section 7031.5 by 'any applicant for a permit
subjects the Spica I to a chd penafy of not more than five hundred dollars ($500).
❑ 1, 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
Prolessins Cade. The Contractors License Law does not apply to an owner of property who
budds or rrproves tlnerem and who does such work himself or through his own employees,
provided ,hal such improvements are not intended or offered for sale. If, however, the building
or irprovernerd is sold witch one year of completion, the owner -builder will have the burden
or proving Via he dld not build or irprove for the purpose of sale.)
❑ 1,43U=01 the property, an exclusively contracting with licensed contractors to con-
struect. (Sec. 70e4, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or approves thereon, and who contracts for
such projects with a conbactr(s) ficensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec a_ & P.C. for this reason
Date owner
WORKEFW COMPENSATION DECLARATION
I affirm that 1 have a certificate of consent to self -insure, or a certificate of
wo
pensation Insurance, or a certified -copy thereof. (Sec. 3800, Labor Code.)
Policy No company 4 ✓" < L
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(1►os section need not be conplaed if the permit is for one hundred dollars ($100) valuation
or less-)
I certify that in the performance of Ihg work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
N077CE TO APPLICANT: If. after makfrlg this Certificate of Exemption you should become
su*Ct to the WOVII rs' Canpensatim provisions o1 the Labor Code, you must forthwith
cbnply with such provisions or this Dem* shag be deemed revoked.
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.)
Lender's Name
Lenders Addnxs
This is abuilding permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 100 days.
I certify that 1 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
Signature of applicant Date
Mailing Adrlmsa
City, state, Mp
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
s
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
's Jj
Plumbing
S.M.I.
of
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL SQ. FT.
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
ROUGH WIRING
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. I SQ. FT.
HEATING (FINAL)
WALL SO. FT.
REINF. STEEL
DRINKING FOUNTAIN
TEMP. POLE
URINAL
FT ®
GROUT
ESTIMATED CONSTRUCTION VALUATION $
SERVICE
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
LUMBER GR.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FRAMING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
ROOFING
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
FIREPLACE
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
HOUSE SEWER
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
n '
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION S ��
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURFSIINITIALS
-
GARDEN WALL FINAL