002053 (CONR)•4 �W
P.O. BOX 1504 No. 002053
Building78-105 CALLE ESTADO
Address 55" 955PlArdVd• LA QUINTA, CALIFORNIA 92253
Owner
L kark BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address M). WR lam A.P. Number
Tel.
City Zip
Tom 14AS-79RA Legal Description
Contractor Project Description
LaYNIWrk 0mistruc . m 3.2 -" is Mufts and xelated
Address
80-361 Me. fir. &ncing and iand caping.
City Zip Tel" - "
%a Quinta 92.23 345-288-8
State Lic. City
& Classif. 413636 Lic. # =33 Sq. Ft. No. No. Dw.
a Size Stories Units
Arch:, Engr., "
Designer New.� Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
17848 Skyparc 1P (7141 263-5120
City Zip State MI'malks Mill courtz SMU be hmilkaD
', VTI-i*%z 1 Q7714 Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70 OO) of Division 3'of the Business and Professions Code; and my license is in full force -and
effect.:'
ZONE:
BY:
SIGNATURE Ay _ —7—DATE
*'
MIf11r1lUm Setback Distances: -
OWNER-BUILDER'DECLARATION ((
I hereby affirm that I am exempt from the Contractor's License Law fortthe following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county wh)ch requires a
permit to to construct, alter, improve, demolish, or repair any structure,• prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
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 bests
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 ($500).
❑ I, As owner of the property, or my employees with wages as their sole compensation, will
Estimated Valuation
-•
PERMIT
.=r
. Plan Chk. Dep.
-
Plan Chk. Bal. .
COr1St.
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 ofproperty who
Mech.
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 building
Electrical
or improvement is sold within one year of completion,. the owner -builder will have the burden
o1 proving that he did.not build or improve for the purpose of sale.)
Plumbing
❑ I, as"owner of the property, am exclusively contracting with licensed- contractors to con-
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. .
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason -
Grading
Driveway Enc.
Date Owner
Infrastructure
INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Date Permit
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
construction, and hereby authorize representatives sof ,this city to enter 'the above.
❑ Copy is filed with the city., ❑ Certified copy is hereby furnished.
TOTAL
Validated by:
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
or less.) -
I certify that in the performance of thg 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 Owner
REMARKS
AMOUNT
1..564.96
1,904.54
334.00
5{8.€ 0
41.21.
758.00
NOTICE TO APPLICANT: If, after making this Certificate or Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
MIf11r1lUm Setback Distances: -
Front Setback from Center. Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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 Permit
I agree to comply with all"city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof ,this city to enter 'the above.
mentioned property for insp'ction purposes. £
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
A 4 2 9 0
2 18 4661;.71 1[
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. 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.000L HOOD
SIGN
I WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR :SUSPENDED
OTHER APP.IEOUIP.
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
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SO.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.IEOUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL.
IIVJYCV 1 V M"J .11UNA 1 UMr W1n11 I INLA,
GARDEN WALL FINAL