05409 (CP)u,��r,`crcv
P.O. BOX 1594
_ No. 05499
Building ( 7&105 CALLE ESTADO
Address y%%— r L !' l 1. �/q LA QUINTA, CALIFORNIA 92253
City, State, Zip
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number"./"1' %�'X i`6 "!>'`Y �G{.�GZ
Legal Description
Project Description M 51
Mailing
Address /.[ 1? v 'r�
City
(� j
Zip
{
Tel.
.� ! r / ,
Contractor
Address
City
A � -� �.:�
Zip
/? 7 —5 `/
Tela
--�o 7U-
State Lic.
City
& Classif. /� rI 970
Lic. #
Sq. Ft.
Size
No. No. Dw.
Stories Units
Arch., Engr.,
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 �� - . y�, �i /. Ir
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,Busbess 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 rile a signed statement that he is licensed pursuant to
the provisions o/ 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 basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the appicant to a clv8 penalty of not more than rive hundred dollars (8500).
❑ 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
Prolessions Code: The Contractor's License Law does not apply to an owner of property who
builds or k proves 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
or improvement is sold within one year of completion, the owner -builder will have the burden
o/ proving that he did not bull or kwrove for the purpose of sale.)
Estimated Valuation
^7�
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.h-
_
Const.
r t.
Mech.
` • / `� `'
Electrical
a ;_ J
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 o/ 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
S.M.1.
Grading
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified,66py thereof. (Sec. 3800, Labor Code.)
Policy No Company 4 -
O Copy is filed with the city. ❑ Certified copy ii hereby furnished.
TOTAL
REMARKS
r
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation`'il.Tf1"'b
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
�''f-t,♦f INt.,. i'G,ti. t1 i`�
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of Califomia.
Date Owner
NOTICE TO APPLICANT: ft, after making this Certificate of Exemption you should become
subject to the Workers' Cornpensaeon provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
Ihereby 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
Lenders Name
FINAL DATE
Issued by:
Validated by:
INSPECTOR
Date Permit
Lenders 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 cerlity 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 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
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUM -RING FEES
IST FL. SQ. FT. ® $
UNITS !
•
SLAB GR
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
(ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO, F7. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT.
GAS (FINAL)
TEMP. POLE
WALL SQ. FT.
DRINKING FOUNTAIN.
ROUT
WATER HEATER
URINAL
SQ FT ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
cu. yd.
$ plus x$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.jj��
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
VENTILATION
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMMERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
GAR. FIREWALL
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® t Y< c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
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
R ND PLUMBING
UgERGROUND
A.C. UNIT
COLL. AREA
SLAB GR
ROUGH PLUMB.
fNGr
q;7HEATING
(ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
'n
GAS (ROUGH)/ 9GJ
!/
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
1112
F. S
GAS (FINAL)
TEMP. POLE
ROUT
WATER HEATER
SERVICE
FINAL INSP.
:;26O>D BEAM �iC
U
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
'6411, -
LUMBER GR.
FINAL INSP.jj��
FRAMING
FINAL INSP.
ROOFINGAe-
e n4K l l �
5,- /
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
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