003483 (SOTB)Building
Address
Owner
Mailing
Address
City
Contractor
t wniex',>f $
Address ,
5 Juarez Avenue
5 Awn. .Ta�Ar^.ty
Zip
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P.O. BOX 1504 NQ. uu,54146-1
78-105 CALL E ESTADO
LA QUINTA, CA_IFORNIA 92253
EUILDING: TYPE CONST. OCC: GRP.
F.P. Number 77A.-1 nIA -Al Q
Legal Description
Froject Description 117`4 rRoir.7 ..�,
City
Zip _
Tel.
State Lic.
City
& Classif.
Lic. #
Sq. Ft.
No. No. Dw.
Size •
Stories Units
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. .
SIGNATURE DATE
_
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
7031.5,Business Code: Any
"
rall
reason: (Sec. and Professions 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
"•ro-'�. •.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 theiefrom,' 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 (;500).
Plan Clik. Bal.
O 1, 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
Const.'
Alp A(Ili)
• .Contractor's License Law does not apply, Yo an owner -of- property who
• 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.
-
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.) -
O 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•1•
+•
• such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
'
Grading.
. ❑ I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date owner - - %. `• !;- -
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
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: It, after making this Certificate or 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
coNSTRucrloN LENDING AGENCY
Side Street Setback from Center. Line
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
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 is correct.
'
Issued by:
Date Permit
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.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. 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 APPJEOUIP.
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
6
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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 APPJEOUIP.
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
6
BEc
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESHr
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
IMJYCI:I V M"J W UMA I UMCJ/I MI I INLJ _
GARDEN WALL FINAL