001679 (RR)Building
Address 77-595 ChUe So
Owner
4t1,t x XichamU
Mailing
Address P.O. D= 578
City lZip
La .Quints . 32253. .
nr
el.
4
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. 001679
BUILDING: TYPE CONST. VV 'OCC. GRP.
A.P. Number
Legal Description
Project Description 185' Of C -exam
re -T tt 19 -=res
eta
...50'
of fhigh fence
City'
a
Zip
Tel."
State Lic.
City
& Classif.
Lic. #
Sq. Ft.
Size..
No. No. Dw. x
Stories Units
Arch., Engr., .. .
Designer
New ❑ Add ;CSI
Alter ❑ Repair ❑ Demolition ❑'
Address
Tel.
City
Zip
State
Lic: #
- LICENSED CONTRACTOR'S DECLARATION
hereby affirm that I am licensed under provisions of Chapter 9 (commencingwith Section
70 OO) of Division 3 of the Business and Professions Code, and my license'is'in full force and'
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
EStIfT181ed Valuation
9A�1
-3 -�f9
reason: (Sec. 7031.5,Buslness 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 that.he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any .applicant for a permit
'
•-
PERMIT -
-
AMOUNT
Plan Chk. Dep.
-
' subjects the applicant to a civil penalty of not more than'five hundred dollars ($500)"
❑ 1, as owner of the property,, or my employees with wages as their sole compensation, wilt''
Plari Chk. Bal.
25.02
Const.
C
• do the work, and the structure is not intended or offered for sale. (Sec..7044, Buisn. and
Professions Code: The Contractor's License Law does not apply to an owner OF props who 'SA
builds or improves thereon and who does such work himself or through his own,#mployees,
.provided that such improvements are not intended or offered for sale. If,. however, ,the, building
Mebh.
Electrical
��QQ
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.)
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
S. V.
� rn
such projects -with a contractor(s) licensed pursuant to the Contractor's License Law.) '
❑Jam exempt under Sec. B. & P.C. for this reason
r f
Grading
Driveway Enc.
Date �;; s j"i*,Owner V ' > 4/_
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
O Copy is filed,with.the city. ❑ Certified copy is hereby furnished.
TOTAL
80.02
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS.
-
(This section need not be completed If the permit is for one hundred dollars ($100) valuation
or less.) - - -
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 of 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 Distances:
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
FINAL DATEIN"_S-^f
Issued by:
Validated by:
Validation:
A 2 3 2 6
�PECTOR
Date S—1 3r Permit
8 R 0 2 CK
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 1 have read this application and state that the above information is correct.
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 -
men If oned property for inspection purposes.;.
Signature of applicant /*'� l' % .: 1 /
Mailing Address y /
-
City, State, Zip !
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SO. 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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (RO.UGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
ROCK STORAGE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
OTHER APP./EQUIP.
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
WATER SYSTEM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTA— 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 (RO.UGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. ]
1
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
�"
C /
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS,
GARDEN WALL FINAL
KItc. 0 r, It
yV IaV — UI / 9 is