07205 (BLCK)4
P.O. BOX 1504 No. 0:7205
205
Building 78-105 CALLE ESTADO
Address 53.750 Juarez LA QUINTA, CALIFORNIA 92253
Owner
Rembert E. 0oues-
Mailing BUILDING: -TYPE CONST. OCC: GRP.
Address - 774-151.002.
A:P. Number
City Zip Tel
Legal Description
Contractor - 2: 8 150' ret" W41Project Description
P. Mzhaei Shea
Address
53-195 Rmlxez --
City Zip Tel:
La Qatinta 1.92253 564-31P _
State Lic. City
& Classif. 382205 Lic. # 1405 Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories ' Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address 7 Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION /
I hereby affirm that I am licensed Wader provisions of Chapter 9 (commencing with Section
7000)' f Division 3 of the Business and Professions Cade, and my license is in full force and */
SIGNATURE .t DATE
oYYNERBURDEADECLARATION Estimated Valuation
I hereby affirm that 1 am em
'exempt frothe Contractors License Law for the following
reason: (Sec. 7031.5,Bus-cress and Professions Code: Any cry or comfy which requires a $2,250
Permit to construct after. improve. demo- I or repair any structure. prior to as issuance also
requires the applicant for such peri m We a signed statement that hes Acensed pursuant to PERMIT AMOUNT
the provisions or the Contractor's License raw, Chapter 9 (commencing with Section 7000) or
Division 3 or the Business and Pnstssarns Code, or tial. he is exempt therefrom, and the basis
I& the alleged exemption. Any vioFiion of section 7031.5 by any appicarnt for a permit • Plan Chk. Dep. -✓'`
subjects the applicant to a civil penalty of mat more than five hundred dofas (5500).
❑ 1, 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 interhded or offered for sale. (Sec. 7044, Buisness and Const.
Professions Code: The Contractors License Law does not aPpry to an owner or property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements am not intended or attired for sale. f. however, the building Mech. i
or improvement is sod wffm erre year of conplebon, the ohmer4mutder will have the burden Electrical
or proving that he did not build or krprove Lor the purpose of sale-)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
struct the project. (Sec. 7044, Business and PrWessons Code: The Contractors license Law
does not apply to an owner of properly who builds or improves thereon, and who contracts for;
• such projects wah a conbador(s) licensed pursuant to the Canbactor's License Law.) $. M. 1.
❑ I am exempt under Sec________i3. S P.C- for this reason
Grading
Driveway Enc. i
Date owner Infrastructure
WORKERS COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800. Labor Cade.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is thereby furnished -
TOTAL
CERi1FICATE OF EXEMPTION FROM REMARKS
WORKERS COMPENSATION INSURANCE
(This section need not be completed 0 the permt is for one hundred dollars ($100) vafuaton f
or less.) -
I certify that in the performance of "work for which this permit is issued, 1 shall not t
employ any person in arty manner so as to become subject to the Workers' Compensation
Laws of California. 1
Date Owner
NOTICE TO APPLICANT: f, after rrraUig this Certificate of Euenptim you should become ZONE: - BY:
omplywthto such�*visaser shaltae' Compensation °�deemeddr of the t yO" m`a'st forthwith Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the Sloe Street Setback from Center Line
work for which this permit is issued. (Sec. 3097, Civf Code.) Side Setback from Property Line
Lenders Name
Lenders Address FINAL DATE INSPECTOR
This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days 2/
� S yJ/�
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 authorme 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
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
FOR. Sp, Ff. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CARP. SQ. FT. ®
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SQ FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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.
SQ. FT. ® c
BATH TUB
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
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
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 APPIEOUIP.
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
t