003128 (BLCK)414o
P.O. BOX 1504 N O. 003128
Building. 78-105 CALLE ESTADO
Address ',7.8-489 "490 Calle .0rense LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE -CONST. • 'OCC. GRP.
Mailing
Address P . n T4^w 8IA A.P. Number 617-442-0091 008 -
Zip Tel.
La
' 11ui1L'�3 �3-�Z' 77 .. .. Legal Description
Contractor. Project Description roof wane.. wrout?lit iron
fvriAlran i2
.Address ..... _
City. _ .. Zip .. . . _. .... Tel...... .
La -Qmi tz 12253 56 -2j177
State Lic. City
& Classif. ow. ex iid- er Lic. #
Arch., Engr.,
Designer
Address Tel.
Sq.Ft, s No. No. Dw.
la€�.: .
Size • - .Stories Units
New p_ Add O Alter O. Repair ❑
Demolition -0
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
V.
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Estimated. Valuation
I hereby affirm that I am exempt from the Contractors. License Law'for the following
ck�'
$2;oox
. reason: (Sec. 7031.5,Business and. Professions Code: Any city or county which requires' a
- ... .
permit to construc!; 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 of the Business'and Professions. Code, -or mat: he. is exempt therefrom; and the basis
for the Any Section 7031.5 by 'any for
. .
Plan Chk. Dep. -
alleged exemption. violation of applicant a permit
subjects the, applicant to a civil penalty of not more than five hundred dollars (5500).
Plan Chk. Bal.
❑ I, as owner. of the property, or my employees with wages as their sole compensation, will
x`36
do the work, and the structure is not intended or offered for saW, (Sec. 7044, Buisness and
Const.
ProfessionsCode: The Contractor's License Law does not apply to an-ownerof property who
builds or improves thereon and who does such work himself or through his own employees,
McCh'.
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 no( 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
. ..O I am exempt under .Sec. - B. 8 P.C. for this reason
Driveway Enc.
Date r �.. Owner �+ .y n `'%%.%'»f...-er
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
O Copy is filed with the city. ❑ Certified copy is hereby. furnished.. '
TOTAL fiat_
CERTIFICATE OF EXEMPTION FROM `'
REMARKS
WORKERS' COMPENSATION INSURANCE
This section need not be completed if me
( p permit is for one hundred dollars (5100) valuation
€a;= -.-"-y
k!�#"•A.t:r�(-•r•...�; �:
or less.) ..... .. .. -
�• �.,�,. _ u.__...... .".. ., _...,.
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.
" Dale 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
comply with such provisions or this permit shall be deemed revoked. a
Minimum Setback Distances: -
*w
Front. Setback from Center Line
Rear Setback.from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
I hereby affithat there is a construction lending agency for the performance of the
whicrm
work for h 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 this '-Issued
t j
'by: �1 �f
read application and state that the above information is correct.
I
Date Permit
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 FFs,
IST FL. SO. FT. ® $
2ND FL. SQ. FT. ®
POR. SO. FT. @
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. 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 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 APP./EQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
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
c
SO.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
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./EQUIP.
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
c
s
:t DEC 17 19k
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE. FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL
I
1\