001702 (GRES)T_ V -y 4 4 Qubt&
Building
Address 52--525 AqwOa J
Owner
Mailing'
Address 51-525 AverJ4a Juamm
City Zip Tel.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
la Qatnta. 92253 1 .%
Contractor
Address
City Zip . Tela
State Lic. City.
& Classif. Lic. #
Arch., Engi.;
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter (commencing with Section '
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.. .....
SIGNATURE DATE
No. 0017020
BUILDING: TYPE CONST. VN OCC: GRP. R 3
A.P. Number 77.x"'042-011
Legal Description
Project Description
Chtd f 3Cje rcimlt
Sq. Ft.
Size -
New C
Add ❑
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county .which requires a
permit to construct, alter, 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 of 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 applicant to a civil penalty of not more fhan'live hundred dollars ($500). -
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
Professions Code: The Contractor's License Law does not. apply. to an owner of property, who.
EStlmated VdlUatlOn
PERMIT '
Plan'Chk.,Dep. '
Plan Chk. Bal. ' .:
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.'
Electrical '
or improvement is sold within one year of completion, the owner -builder will have the burden...
of proving that he did not build or improve for the purpose of sale.) _... _
Plumbing
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
strucl the project. (Sec. 7044, Business and Professions Code: Me Contractor's License Law
•^
does not apply to an owner of property who builds or improves. thereon, and who contractsforS.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's Ocense Law.)
❑ 1 am exempt. under Sec. - B. & P.C. for this' reason
Grading
Driveway Enc.
s ,
Date Owner' 1(: �.�`"�
Infrastructure
WORKERS' COMPENSATION DECLARATION
' Date Owner
'.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.)
NOTICE TO APPLICANT., If, alter making this Certificate of Exemption you should become
Policy No. Company
BY:'
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
Minimum Setback Distances: '.
TOTAL
No. No. Dw.
Stories Units -
Alter ❑ Repair ❑ . Demolition ❑
AMOUNT
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.)..
I certify that in the performance of the 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
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. -
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
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 if work thereunder is suspended for 180 days.:
I certify that I have read this application and state that the above information incorrect.
Issued by:
Date 14-4 tlRl; Permit
I agree to comply with all city and county ordinances and state laws relating to'building
construction, and hereby authorize ireprese�ntatives �Df this city to enter the above- '
mentioned property for inspectio{n purposes.
'
Validated by:
Signature of applicant 1 \ Date
Mailing Address f '
Validation:
City, State, Zip f
A255.7
9 10. 11362 R
HARD COPY
CONSTRUCTION ESTIMATE
s NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL.SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT.
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
r 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.IEQUIP. r
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
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE IPL.CK.FEE
CONST. FEE ELECT. FEE
.SMI FEE PLUMB. FEE
STRUCTURE ° PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
ROUND PLUMBINGS—,,;�
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.IEQUIP. r
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
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL