10854 (BLCK)P.O. BOX 1504 ,• No.. 1.0854
`Building 53-985-Navai � 78-105 CALLE ESTADO
Address :LA.QUINTA, CALIFORNIA 92253
Owner
Ed Correa
Mailing
Address 17563 Xnight• Dr
City Zip Tel.
..
Castro wile . 94546 510/ 381--0331
Contractor
/, a
dr
Address
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number'
Legal Description ,
Project Description
Remodel:.-. Blodk wall- - Spy
180 if
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
Zi
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. ,
,a
... .. .. .. .... .
_SIGNATURE - - .DATE
' OWNER -BUILDER DECLARATION .
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, after, Improve, demolish, -.Or repair any structure, .prior to its issuance also
.requires the applicant for such permitto rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License taw, Chapter 9 (commencing with Section 7000) of
' Division 3 of the: business and Professions Code,' or that. he is exempt therefrom, - and the basis
' for:thelatleged exemption..,Any violation of Section 7031.5 -by 'any applicant for a'pemdt =
subjects the applicant to a civil penalty of not morethan.frve hundred dollars .($500): T,.
as owner of the property, or my employees with wages, as their sole' compensation, will
'o the work and the structure is not intended or offered.for sale.'(Sec.• 7044;'Buisness and
Professlons; Code: The Contractor's License Law, does not apply to an owner of property who
Estimated Valuation .fl� I
6' V 0
•- Iti
- PERMIT AMOUNT.
Plan Chk. Dep. . • .-- • _
Plan Chk., Bal. i 65
COrISt.' ' >► • V
.Mech.-+
- _'•t. ', i
builds or improves thereon and who does such work himself or through his own employees,
provided that such Improvements are not. intended or offered. for sale. -B, however, the.building -
or improvement. is'so/d within one year of completion, the owner -builder will have the burden
. of proving. that he did not butid or lnprove for the purpose of sale.) •
Electrical -
t • F'
_ ,
Plumbing -
❑ I, as owner of the property, am.exclusively contracting with licensed contractors to con -
'• struct the project. (Sec. 7044, Business and Professions Code: The, Contractor's: License -Law
does not apply to an owner of property *who,builds or:Improves.,thereon, and who contracts -for ..
- - - such projects with a contractor(s) licensed p_•ursuanhto'the Contractor's License Law.) -
-: t under Sec. f
O -I am exempt B. 8•.P.0 forthis reason
S:M.I: -•• - '•r,"� - • {
-
Grading
Driveway Enc.
Date Owner -^IA:_ of f .r r�...r r
Infrastructure
WORKERS' COMPENSATION DECLARATION ' •
-
'1
' , I hereby affirm that I have a certificate'of consent to self -insure, ora'certificate of
Worker's Compensation Insurance, ora certified copy thereof(Sac. 3800, Labor Code.) -
Policy No.: -.Company
Com any
n
4 r413f 't a$
,
,
❑ Copy is filed with the.city. ❑ Certified'copy is hereby furnished.
TOTAL J. $ . Z5
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE'.
• (This section need not be completedd �ihe permit is for onerhundred, dollars ($100) valuation
orless.):. ,,.:- / .. . -#F - e
I certify that in the performance of thg work for:wtiich this permit Is issued, I shall not
employ any person in any manner so as to beconie•subject to the•Workers' Compensation'
Laws of California. _ t,,.:j e.__ P..f ; r /
Date : Owner F:.- t. C f .�, :(�'.-t
NOTICE .TO APPLICANT: d, after making this Certificate -of Exemptionyou. 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. -
REMARKS
-
-
ZONE: BY:
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: lendig agency for the performance of the
work for which this permit is.issued. (sec. 3097, civil Code.)
Side Street Setback from Center Line -
• . - ` _,
Side $etba0k,frOm Property'Line .
Lenders 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.
~ 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.,
Date -Permit-
Issued by; .
Validated by: �-
Signature of applicant Date
Mailing Address
Validation: -
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT. ®
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. S0. FT. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT. ®
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER HEATER
SERVICE
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
REMARKS:
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
/
LATHING L
i
MESH
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 V4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
FINISH GRADING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.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 l �J w
(^
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING L
FINAL INSP.
ROOFING
1
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
/
LATHING L
i
MESH
INSULATION/SOUND
FINISH GRADING
5�
FINAL INSPECTIONlip
CERT. OCC.
FENCE FINAL VV
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL