003396 (BLCK)44a
\\ P.O. BOX 1504 No. 003396
Building 78-105 CALLE ESTADO
Address 52-110 „t'y.y^mv, LA QUINTA, CALIFORNIA 92253
Owner
-• BUILDING: TYPE CONST. OCC: GRP.
Mailing `
Address A.P. Number 773-211-009,
City Zip Tel. -
Legal Description
Contractor Project Description 302 Hicft X 49' FdE• liY.iiCE M11
RM _
Address _
F. 0. B= 3535
City._. Zip " Tela
palm Desert 92261 346-3962
State Lic. City
& Classif. . 458575 Lic. # _ Sq. Ft: No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. # -
LICENSED CONTRACT,OWS DECLARATION
I hereby affirm t�t I amJlicensed under provisio s of Chapter 9 -(commencing -with Section sr
7000) of Division 3 of the /business an&Professlons Code, 'and my licensees:in full force and
effect. <r � 1- 7 * +-•---: `r V lr�,-
R X r �/..++'' rz J
SIGNATURE r X ! .% f -.1" DATE
OWNER•BUILDER DECLARATIONEstimated
I hereby affirm that I am exempt from the Contractor's License law for the following
Valuation
• reason: (Sec. 7031.5,Business and, Professions Code: Any city or county .which requires a,
Distances:
permit; to construct, after, improve, demolish, or repair any structure, prior to its issuance also
Front Setback.from Center Line
requires the applicant for such permit to file a signed statement that he is•licensed pursuant to
PERMIT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Side Street Setback from Center Line
Division '3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any Section 7031.5 by 'any
Plan Chk. Dep.
violation of applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). -
FINAL DATE
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Bal.
if do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
Professions Code: The Contractor's license Law does not apply to an owner of property who
'builds
. or improves thereon and who does such workhimselfor through his own employees,
-Mach.
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 not build or improve for the purpose of sale.)
❑ 1, 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.
Infrastructure
Date nwnar
WORKERS' COMPENSATION DECLARATION
I hereby affirm that l 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:
CERTIFICATE OF EXEMPTION FROM
WORKERS' COM PENSATIO N INSURANCE .
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.) - - _
1 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, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
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 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 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
City, State, Zip
HARD COPY
TOTAL
REMARKS
AMOUNT
X243.
On
ZONE:
BY:
Minimum Setback
Distances:
Front Setback.from Center Line
Frear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side -Setback from Property Line.
FINAL DATE
INSPECTOR
Issued by:
Date Q/!1P /R7 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SO: FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
. CAR P. I 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
FOLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER, B.T.U.
SO. FT. ® c
BATH TUB
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
AMECH.FEEPL.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
S GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
/
MS �
c
,
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
AND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
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