002667 (RR)P.O. BOX 1504 N o 002 .
Building78-105 CALLE ESTADO
Address D $� �' a LA QUINTA, CALIFORNIA 92253
Owner �.....
La G fYBUILDING: TYPE CONST. -OCC: GRP. --
Mailing' -
Address
A.P. Number - 1
City Zip Tel. \
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.Legal Description
Contractor.
Wall= 113bof im, cc
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City' _ .... ... Zip_
State Lic.
&.Classif..,274 921
Arch.,'Engr.; -
Designer.•
Project Description
MY
City
Lic. #
40 Sq. Ft.-.
Size ..
New•. Add ❑
No. No. Dw.
.Stories... ,Units....
AlterO .Repair p -.• Demolition'.❑
Address
Tel.
_
City
Zip
State
Lic. #.
_ LICENSED CONTRACTOR'S DECLARATION.
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•
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SIGNATURE y re DATE
OWNER -BUILDER DECLARATION
from the Contractor's License Law for the following.
I hereby affirm that I am folio
reason: (Sec. 7031. S,t3usiness, and Professions Code:. Any. .city or, county which requires _a
Estimated Valuation
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PERMIT ..•
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_ - `-AMOUNTZ-
. permit to construct, atter, improve, demolish, or repair any structure, prioir'to its issuance -also -
requires the applicant. for such, permit .to file a signed' statement.ahat*he is licensed pursuant. -to-.,
the provisions of the Contractor's License. Law,. Chapter 9 (commencing with. Section .7000). o/
' -.Division of the Business and'Professions Code, or lhat.he is"exempt therefrom, and the basis'
• 'for the alleged exemption. Any violation of Section 9031:5 by 'any. applicant for a, permit
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'subjects the applicant to a civil penalty of not more than five hundred dollars ($500):, ' C:' ." '•
0 I, as owner of the property, or my employeesviith wages as their, sole compensation, wilt._
. -do the work, and, the. structure is not intended or offered -for sale: (Sea 7044, Buisness and'.'
Professions Code: The Contractor's License_ Law.does not 'apply to.an'owner of..property who
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•• builds of improves' thereon and who does such work himself or through his own employees, --
. , provided that: such improvements are not intended or offered. for'sale. If, ,however, the building
-
Electrical.0
or improvement is sold within one year of *completion, .the owner -builder will have the: burden
of proving that he did not build. or improve /or the,purpose of sale.)'.
Plumbing
O I, as owner of the property, am exclusively. contracting with licensed contractors to con-
-- -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 improvesr thereon, and who contracts /or
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'• ' - .50- '
such projects withcontractor(s) licensed pursuant to the Contractor's License Law.) . • - ..
0.1 am exempt under Sec. --- . B: & P.C. for this reason -
_ ...
Grading
+
Driveway Enc.
' Date' Owner '
Infrastructure
WORKERS' COMPENSATION DECLARATION
.
' I' hereby'affirm that I have a certificate of consent to self -insure, 'or a'certifioate of '
Worker's Compensation Insurance, or a certified copy thereof. (Sec: 3800, Labor Code.)
_ Policy -No. .. _ .. ,Company , ..
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❑ Copy is filed with the city, 0 Cerlified.copy is hereby -turn ished.
TOTAL
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CERTIFICATE OF EXEMPTION FROM
:WORKERS'. COMPENSATION INSURANCE .- .. .. _
REMARKS
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(This section need not be completed if the permit is for one hundred dollars (S100)"valuation
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: If, after making this Certificate o/ 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. - -
ZONE: BY: " -
: Minimum Setback DlStances: ..
Front -Setback -from. Center Line'
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY - .. -
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 Street Setback from Center. Line
Side Setback from; Property Line-
ine-Lender's
Lender'sName
FINAL;DATE ;
Issued .b
Y
Validated by:
y
" INSPECTOR
Date "�fPermit
r•
Lender's Address
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. -
ays:I.certifythat I have read.this application.and state that the above information is correct: -
1 -certify that
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 ins pectiioo�purposes. : �`
Signature of applicant a -Date r''-' %
-7--&-,s
Mailing Address
Validation:
_ _
City, State, Zip l
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SQ. FT. p
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. 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.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEOUIP.
LAUNDRYTRAY
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
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 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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL _