002987 (BLCK)53_2"g,j P.O. BOX 1504 N O:..
Building 78-105 CALLE ESTADO
87
Address 53-300 ,pa', uniiidd Nwc'4Z'ro LA QUINTA, CALIFORNIA 92253
.,.Owner - .. .... .. d ....
Mailing
BUILDING: TYPE CONST. OCC: GRP..'..
Address 9538 .$r�. Way A.P. Number 774-095
City Zip Tel. ,
�'rly all90Legal Description 's
Contractor Project Description
...Address .. • . 50-14n. .
73-925 eXn .-WW Ill 50 iin ft./40" FetainimAkal - lot 24
.. _City .Zip ±Tely ARIM Det, GA92263U-3,266
State Lic. & Classif.. 473053 #- 784. Sq. Ft. No. No. Dw.
Size Stories - Units
Arch:, Engr.;
Designer New IK Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
CityTIp
State
-Lic. #
LICENSED CONTRACTOR'S. DECLARATION
I hereby affirm that I am licensed-under provisions of Chapter9 (commencing with Section
7000) of Drvlsion,3.oflthe Business and Professions Code, and my license is in full force and
ll effect:" a.
SIGNATURE A ! DATE
OWNER-BUILDER DECLARATION Estimated Valuation
pp
I hereby affirm that I am exemprfrom 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; 'atter, improve,,demolish, or repair any 'structure, prior to its issuance also ry AMOUNT
requires the applicant for such permit.to file a signed statement that, he is.'licensed pursuant to PERMIT'
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or. .•i'
Division' 3 of the Business and '• Professions -Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.., '
subjects the applicant to's civil penalty of not more'than'rive hundred dollars-($500).
O I, as owner of the property, or my employees with wages as their sole'compensalion, will Plan Chk.' Bal. °y''.., 20,15
do the work, and the structure is not intended or•offered for sale. (Sec. 7044, Buisness and COf1St
Professions 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 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 -
or proving that he did not build or improve /or the purpose of sale.)
❑ I, as owner ofthe 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 'S. M. 1. - •d
such projects with a contractors) licensed pursuant to the Contractor's License Law.) -
Grading
. O I am exempt under Sec. - B. 8 P.C.-for this reason
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
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. (Sec. 3800, Labor Code.)
Policy No. Company
q Copy is-filed with the city. ❑,Certified copy is hereby furnished.
TOTAL Jr.6
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE _
(This section need not be completed it the permit is for one hundred dollars ($100) valuation - -
or less.)
I certify that in the performance of thg work for which this permit is issued, 1 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, alter making this Certificate of Exemption you should become ZONE: - BY:,
subject to the Workers' Compensation provisions of 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
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 R•
This is a building permit when properly filled out, signed and validated, and-is subject to 7� Eq FINAL DATE INSPECTOR-
expiration Permit
expiration if work thereunder is suspended for 180 days. 3/.L E �Q f
I certify that I have read this application and state that the above information is correct. Issued by: Date
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
B 7 5 1 3 3 12 u50 11
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
A.C. UNIT
2ND FL. SQ. FT. ®
SLAB GRADE
YARD SPKLR SYSTEM
POR. SQ, FT, ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®
ROUGH WIRING
DRAINAGE PIPING
WALL SQ. FT. ®
DUCT WORK
DRINKING FOUNTAIN
SO. FT. ®
GAS (ROUGH)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
HEATING (FINAL)
OTHER APPJEOUIP.
C?j4REINF. STEEL �/
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
SERVICE
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FRAMING
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.
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
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.
C?j4REINF. STEEL �/
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
r�
/ ND BEAM ✓
WATER SYSTEM
$
GRADING
CU. yd.
plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
_
djA
O iii"
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