001757 (RER)6,
Building
Address 50-920 calla Pala
Owner
Mailing
Address P.O. Box 1132
City Zip
7.a ' CA_ulnta 92253
Contractor
T4ht 4 4-Qur«rw
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Tel.
. 56,41-3550
Zip . _ Tel.
No. .0017 7
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number : ' Legal Description
Description
Project Description riie Place
State Lic.
City
Minimum Setback Distances:
& Classif.
Lic. #
Sq. Ft.
No. No. Dw.
Side' Street Setback from Center Line
Size
Stories Units •
Arch., Engr:,
INSPECTOR
Issued by;
Designer
New Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
A296i
10 23 i5,5G CK
City
Zip
State
Lia'#
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..
SIGNATURE DATE
.. -
.. .
' OWNER -BUILDER DECLARATION'
Estimated Valuation
.l hereby affirm that I am exempt'from the Contractors. License Law for the following
,,�,�p� �p
1p3:�Li�4dt"
. reason: • (Sec.. 7031.5, Business and Professions Code: Any city or county which requires. a
permit to construct, after, 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
PERMIT
r
• AMOUNT '
the provisions -of the Contractor's License Law, Chapter 9.(commencing with Section 7000) of
' Division 3 of the Business and Profession's Code, or that. tie. is exempt therefrom, and the basis
Any Section 7031.5 'any for
Plan DO.
.
for the alleged exemption. violation of -by applicant a permit
' subjects the applicant to a civil penafty of not more than five'hundred dollars ($500). ' -
. .Chk.
Plan Chk. Bal.
O I, 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
-an
Const.��1
. Professions Code: The Contractor's License Law.does not apply to owner of.property who
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
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.)
• 0J, 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. .•
t'ai
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
•
Grading
❑ 1 am exempt under -Sec.. B. & P.C. for this reason
r i
Driveway Enc.
IT. f :>L f Owner { + x. P -f
Infrastructure
Date rpt -
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.
TOTAL
5
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION. INSURANCE
(This section need not be completed ifthe 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
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become
subjectto the Workers' Compensation provisions of the Labor Code, you'must forthwith
comply with such provisions or this permit shall 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
Lender's Address
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.
I agree'to comply with all city and county ordinances and state laws.relatirig to building
construction, and hereby authorize representatives -of this city to' enter the above-.
mentioned property for inspection purposes. w .,
Signature of applicant }. ( 1 : rL; Date >�`S
Mailing Address '. a v i ! �✓
City, State, Zip r
HARD COPY
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 Z — — Permit
Validated by:
Validation:
A296i
10 23 i5,5G CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. I SQ. FT.
WALL SO. Fr. ®
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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 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 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
REMARKS:
VENTILATION
FIRE ZONE ROOFING -
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
I N SU LATIONISOU N D
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
inarw � ter. a awnq i vn��m� i �Nw, - -
GARDEN WALL FINAL