002753 (BLCK)P.O. BOX 1504 Na. 002753
Building 7.ot2 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
ia3 � �ity
BUILDING: TYPE CO�NIST�J OCC-. GRP. -
A. P. -`/•.Number —3o- 7 6 1 a
1
Legal Description
Project Description
Mailing _
Address
CityZip
1a QAntaJ
32253
Tel.
Contractor
TVA"" T POO A11g9�G'__ nCXJfixw
Address..
74-473 1W M
Side Street Setback from Center Line
- G
City..
Palm Desert
Zip ..
92,26
Tel.. ....
560-93619
INSPECTOR
Issued by:.-
State Lic.
& Classjf. 355646,
City
Lic. # 278 .
Sq. Ft.
Size
No. No. Dw.
Stories Units
.Arch.; Engr.,
Designer
New ❑aC Add ❑
Alter ❑ Repair ❑ 'Demolition .❑
T Address
Tel.
City
Zip
State
Lic: #.
"
.- LICENSED CONTRACTOR'S DECLARATION
hereby.afffim that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Dlvision 3 of the Businesand Professions Code, and mylicelse is in full force and
effect..
-
SIGNATURE i'S.Y DATE
i 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, alter, 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
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
' Division 3 of the Business and Professions Code,or thathe is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
' subjects. the applicant toe civil penalty of not more than'five-hundred dollars ($500).
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 .
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,
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
of proving that he did not build or improve for the purpose of sale.) _
❑ 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 properly who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License -Law.)
❑ I am exempt under Sec. B. & P.C. for this reason
Estimated Valuation
-
.. -. PERMIT
•�
-
_ AMOUNT -
-
Plan Chk. Dep.
- -
Plan. Chk. Bal..
Consti_f�
' ' Mech.
.
Electrical
'
Plumbing
S.M.I.
- l3
Grading
Driveway Enc.
Dale 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. (Sec. 3800, Labor Code.)
' Policy No. ' ' . .Company -
4 Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
.(This section need not be completed if the permit is for one hundred . dollars ($100) valuation
or less.) - -
certify that in the performance of the work for which this permit is issued, ishall not
• employ any person in any manner so as to become subject to the' Workers' Compensation '
Laws of California.
h
..
TOTALS
_)
REMARKS
'
-
Date' Owner'
NOTICE TO APPLICANT. If, after making. this' Certificate of Exemption you should become '
'subject to the Workers" Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permitshall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
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 fortinspection purposes.
{.
"I
../
Signature of applicants.-�� i f : . + w-- f . Jr. ID e
Mailing Address -
City, State, Zip `
HARD COPY
ZONE:
BY:
Minimum Setback Distances:
Front.Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL.DATE
INSPECTOR
Issued by:.-
Date 12 -11 -Hermit
Validated by:
Validation:
A6846
12 11 2L5G Ck
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT. g
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ. 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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
SO. FT. ® c
BATH TUB
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FLEE 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
•
®Ev
i JO��
( ,T
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSU LATI ONISOUN D
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
IN51'tG t UM'S WUNA 1 UNt511N1 I IALS
GARDEN WALL FINAL