001794 (BLCK)•
CV
44
P.O. BOX 1504 111 o .
001794
Building 78-105 CALLE ESTADO
Address 77-595 Calle N-4galm LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE -CONST. OCC: GRP.
Mailing
Address P.O. B= 573 A.P. Number
City ZipTel.
�
la.C.. 52253 T. 564-1006 Legal Description
Contractor � J Project Description
.Address..... .. .... .. -
165 -ft. of a&Uti .
125. ft. of (foot Wd fes.
City JZip Tela "
State Lic. City
& Classif. Lic. # Sq. Ft. No. " No. Dw.
Arch:, Engr.,Size Stories Units
' � � _
Designer New ❑ Add :fl Alter ❑. Repair ❑ . Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
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 Valuatione�y�St q tt�1p
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 Js licensed pursuant to PERMIT AMOUNT "
the provisions of the Contractor's License Law„ Chapter 9 (commencing with'Section 7000) of
f 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. 28.12 ��yy �g3
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ,- Plan Chk. BBI. L� e,.7.�G
❑ I, as owner of the. property, or my employees with wages as their sole compensation, will
. do tfie 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 Const. 44..50
builds or improves thereon and who does such work himself or through his own employees,.
MBCfI. `
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.) ..
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-. Plumbing
Strutt- the project. • (Sec. 7044, Business and Professions Code: The Contractor's License Law - -
does not apply to an owner of propertywho builds or improves thereon, and who contracts for S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ""
Grading
❑ 1 am exempt. under Sec. B: & P.C. for this reason
Driveway Enc. i
Date Owner V 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.p
Policy No. .Company
O Copy is filed with the city. ❑ Certified.copy is hereby furnished.. _.
TOTAL y.
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 less.)
I certify that in the performance of thg 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 thisCertificateof 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
I 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 it work thereunder is suspended for 180 days. �q��z
I certify that I have read this application and state that the above information is correct. Issued by: Date J Permit
I agree to comply with all city and countyordinances 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
A3327 11 15 - 7392 Ck
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT. ®
WALL SQ. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTICN 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
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
S
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
ROOFING
GAS PIPING
PERMIT FEE
REMARKS:
PERMIT FEE
PERMIT FEE
DBL
TOTAL =EES
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 OUGH WIRING ,[
7 v
DUCT WORK
ROCK STORAGE
iFOUND. REINF.
S
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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.
�1
T FRAMINGL {U
FINAL INSP.
ROOFING
!/
S/4 b f/
C/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL•
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