002334 (BLCK)Building
Address
51-075 final
Owner
City"
Zip
Tel.
Mailing
Distances:
Address
Lic. #
City
No. No. Dw.
• Stories Units
Zip
. La..Qt%ftta.
. 922 3_
Contractor
Tel.
FINAL DATE
Mill Abarm 'awnext
Address
City
Tel.
4
P.O. BOX 1504 NO, 0092334 �
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
564-1813
BUILDING: TYPE CONST. ' OCC: GRP.-
A.P.
RP. A.P. Number 769-132-006
Legal Description Lot 100
Project Description
S
City"
Zip
Tel.
Minimum Setback
Distances:
State Lic. _ y ":.City
& Classif.
Lic. #
Sq. Ft. f
Size - 110 lin. ft
No. No. Dw.
• Stories Units
' Arch., Engr:,
Designer
New O« Add El -
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
FINAL DATE
INSPECTOR
4 foot* hill StM= fmm
City
Zip
State
Lic. #
r
. 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 isin full force and
effect.
A5393
_ •, -
_ ,
SIGNATURE DATE
' OWNER•BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031..5,Busioess 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.
.the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of.
Divisiori'3:of the Business and Professfons Code, or that:he is exempt therefrom, -and the basis"
. 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 rive hundred dollars ($500). . - -'^ •
0 I, as owner of ttie 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
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. .1f, however, the building
or improvement is sold within one year of completion, the ownerbuilder' will have the burden
of proving that he did not build or improve for the purpose.ot sale.)
O 1, 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 town owner of property who builds or improves thereon, and,who. contracts for
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.
Estimated Valuation
Tat
'
PERMIT.
AMOUNT
'
--
Plan Chk. Dep.
-
-
Plan Chk. Bal.,
Corlst.. -
gi
G.i+.
Meth..
.,
Electrical
_
Plumbing
S.M.I. -
-
Grading
Driveway Enc.
Date Owner '
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. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
TOTAL
20.00
REMARKS.
'
or -less.)
I certify that in the performance of tha 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, after making this Certificate of Exemption 'you should become
subject' to 'the 'Workeis' 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 lendind 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 stale law's 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 Address dK
City, State, Zip
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 s:=' 6Permit
Validated by:
Validation:
A5393
4 24 20.00 DK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ, FT. ®
CAR P. SO. FT.
WALL SQ. FT.
SO. 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 lax 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 APPJEOUIP.
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.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 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
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
IM)PLU 1 UN'J WUNA 1 UntW1m I IALb.
GARDEN WALL FINAL