003889 (BLCK)• ,
P.O. BOX 1504 No. 003889
Building 50-920 Calle Palona 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Dennis Horton _
BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address cSameA.P. Number 769-0744005
City Zip Tel.
T.a Q33 nta 92253Legal Description
Contractor Project Description & ° hack. bl=k .gall
Address -
City Zip Tela
State Lic. City
& Classif. Lic. #. Sq. Ft. No. No. Dw.
Arch., Engr.,
Size -Stories • Units -
Designer
Designer New, ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
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.
SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following.
reason: (Sec. 7031.5,Business and. Professions Coder 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. AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 o the Business and Professions Code, or thaChe-is exempt therefrom, and the basis.
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit, . Plan Chk. Dep. -
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 Plan Chk. Bal. .
do the work, and the structure is not intended or offered.for sale. (Sec. 7044, Buisness and Const" r
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,
provided that such improvements are not intended or, offered for sale. If, however, the building Mech.
or improvement is sold within one year of completion, the owner -builder, will havethe 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
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.)
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Eno.
Date %I' - *= Owner - �?�` ; , i s f. J- —A- i Infrastructure
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
CERTIFICATE OF EXEMPTION FROM - 'REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit, is for one hundred dollars ($100) valuation
or less.) - - t� ( •-•r.
I certify that in the performance of thg work for which this permit is issued, I shall not - ; .� sii�... `1C�3(• A,� i- J"v .i
employ any person in any manner so as to become subject to the Workers' Compensation ;, ; 7J . n� a
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY:
subject 'to the Workers" Compensation provisions of the Labor Code,you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
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
' This'is a building permit when properly filled out, signed and validated,'and is'subject to FINAL DATE INSPECTOR
expiration it work thereunder is suspended for 180 days. 4 l 2 5 j 8
I.certify that I have read this application and state that the above information is correct. -Issued by: Date 4 o 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-.
mentioned property for inspection purposes. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
A.C. UNIT
2ND FL. SO. FT.
SLAB GRADE
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SO. FT.
ROUGH WIRING
DRAINAGE PIPING
WALL SO. FT.
ROCK STORAGE
DRINKING FOUNTAIN
SO FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
HEATING (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
GAS (FINAL)
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SERVICE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
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 APPJEOUIP.
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
t
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL