09247 (PLBG)Building1504
78-1 50CALOLEESTADO �. NO•9'7
AddresS4-205 ,T4 are.2 LA QUINTA, CALIFORNIA 92253
Owner
Mailing
' AAA -'" `� �'� _""`�04 BUILDING: TYPE CONST. OCC: GRP.
Address
A.P. Number
City Zip Tel.
+ ,y Legal Description
Contractor
. Project Description
Address-- Y' 'TT
City Zip Tela
T 4 Angt%ltmn 900203 . —
State Lic. City
& Classif. 262678 Lic. # 1852 Sq. Ft. No. No. Dw.
Arch:, Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I m licensed under provisions of Chapter 9 (commencing with Section
700 0) of Division 3 �e Business and Profession Code, and my license is in full for a and
effect. %�
SIGNATURE D'ATE f
OWNER -BUILDER DECLARATION Estimated Valuation
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 - AMOUNT
requires the applicant for such permit to file a signed statement that.he is licensed pursuant to PERMIT -
the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000)_o/
,. Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis - -d
for the alleged exemption. Any violation o/ 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). Plan Chk. Bal. '
❑ 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 Const.
Code: The Contractor's License •Law .does not apply to 'an owner of property who
builds or improves thereon and who does such work himself or through his own employees, Mech. '
.. • provided thatsuch 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 o/ sale.) .
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 30.00
struct the project. (Sec. 7044, Business and Professions Coder 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
D I am exempt under Sec. B. 8 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' Co pensat'on Insurance, or a certified cop thereoj.1�ec. 3800, Labor Code.) -
Policy ` Q«, ompany S°i'AT irT
❑ Copy is filed with the city.. ❑ Certified copy is hereby furnished.
TOTAL 30.00
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i/ 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.t tn.LL�y
Date Owner 3 �.sdr:i-YO D�.x;:T,7.11?r1a:�"`27-9A l�.ST1.1�X-_0_ -
NOTICE TO APPLICANT: I/, after making this Certificate of Exemption you should become ZONE: � BY: ��5
subject to the Workers' Compensation provisions o/ 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 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
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST 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
WA1 ER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRYTRAY
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.
SO. FT. ®c
BATH TUB
SO. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
`
f�
SO.FT.GAR ® 3/ic
HOUSE SEWER
VENTILATION
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
`
f�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL