002347 (RPL)P.O. BOX 1504 No,
Building51 525 A,�� � LA QUINTA, CALIFORNIA 92253
Address
Owner _
Mailing BUILDING: TYPE CONS7T. • - OCC. -GRP:-
Address A.P. Number f i ji .7 ���
CityZip Tel. ,
-- Legal Description ► "T
Contractor Project Description
Address
S
CityJZip Tel
ceaeeaar, _
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr., Size - 454 Stories -- Units
Designer New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lia. #
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 $ �� a
reason: (Sec. 7031.5,Business and Professions Code: Any -city or county which requires -a•, ai .1 •
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 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 that. he 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).
O 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. ��
Professlons Code: The Contractor's License Law does -not apply to an .owner of property who s
55
builds or improves thereon and who does such work himself or through his own employees, Mech.
provided that such, improvements are not intended or offered for sale. If, however, the building •«4au
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical 121.0
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 G•
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•l; -
such projects with a-contractor(s) licensed pursuant to the Contractor's License Law.)
Grading «
53
0am exempt under Sec.. -B: & P:C. for this. reason .
I _^,, Driveway Enc.
Date Owner Infrastructure
M � _
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 copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O Copy is filed with the city. O 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.) - -
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.
'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 FINAL DATE INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days. - j
,I certify that I have read this application and state that the above information is correct: Issued.by:- Date 4 Permit
1 agree to comply with all city and county ordinanees 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 h 1�1 Date
Mailing Address Validation:
City, State, Zip
A 5 4 8 7 4 30 161.55 11111
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SO. FT. ®
POR. SQ. FT. ®
GAR. SQ, FT. ®
CARP. SQ. FT.
WALL SO. FT. ®
SQ. 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
�3ONDING
FLOOR DRAIN
MECHANICAL FEES
STORAGE TANK
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FOUND. REINF.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REINF. STEEL
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.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FINAL INSP.
SQ:FT.GAR ® 3/ac
HOUSE SEWER
ROOFING
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 CONP. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
�3ONDING
5'
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
pf
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. t
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
a
Q]
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
I N SU LATIONISOUN D
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL