003114 (RR)44
P.O. BOX 1504 N o . 013114
BuildingK 78-105 CALLE ESTADO
Address 53-9 0 h°a'va2mo LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address 53-960 Navarro A.P.-Number_, 774-17�-011 Lot 12
City ZipTel.
.La. inti .92253 Legal Description
Contractor . Project Description Re—roof .. '
Address
74-478 H$cahy 111
City.. Zip Tela
palm np A t 922151A
State Lic. City
& Classif:5j3tD46 Lic. # 27$ Sq. Ft. No.No. Dw.
- Size Stories- - Units
Arch.; Engr.,
:,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�3
-
. reason: (Sec. 7031.5,Business and Professions Coder Any. city or county which 1requires, a
w
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
-- '- -
requires the -applicant for such permit.to file a signed statement that.he is.licensed pursuant to
PERMIT - - '' ? AMOUNT -
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section .7000) of
' -Division .of the Busiriess. and Professions Code; or that. he is exempt therefrom, and the basis
for the Any S6ction 7031.5 by 'any for -a
- - - - -
Plan.'Chk. Dep. •
. alleged exemption. violation of applicant permit
subjects the applicant to a civil penalty of not more than five hundred dollars (3500)`
Plan Chk. Bal.
,. O 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. j&
Professions Code: The Contractor's License Law does not apply to an owner of property -who
a - ,
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:)
❑ 1,. 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
$,M.h. - - ' ' E�
- such projects with a contractors) licensed pursuant to the. Contractor's License Law.)
.50'
Grading
... O 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's Compensation Insurance, or a certified copy,thereof. Labor Code.)
¢j `� _ a"i3 t
(Sec. 3800,
Policy No. Company.-
itC1 a
KCopy is filed with the city. , ❑ Certified copy is+hereby furnished. .
TOTAL $45,40
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 fess.) _
..
I certify that in the performance of tho 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 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 k
colusrRucnoN 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 -
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 1130 days.
I certify -that I have read this
l q e
(3 £i
application and state that the above information is correct. _
' I
ISSued.by: Date Permit
agree'to comply with all city and county ordinances and state' laws' relating to building:
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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
x
HARDCOPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST. FL. SO. FT. @ $
UNITS
SLAB GRADE
2ND FL. SO. FT. @
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. @
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT. @
OTHER APP./EQUIP.
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.
FRAMING
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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, 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.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SQ.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 APP./EQUIP.
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