002547 (AR)P.O. BOX 1504 NO•, 4 6
Building 78-105 CALLE ESTADO
Address 78--133 CaUe Mrte LA QUINTA, CALIFORNIA 92253
Owner...... .. .... ... ... .. ... ..• . .. .
BUILDING: TYPE CONST. OCC: GRP..'-"
Mailing _ _
Address P.O. B= 100 A.P. Number 76 i22- s
- City Zip Tel. _....
Legal Description
La 0ainta 9M3
Contractor ...... ..
- Project Description,MtMa La +'
'3"bm KeMMdV
Address
35nZIP
City . Zip Tel. .. _... .
La Qlail" 9M3 564 -4660, -
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
X142118 469_ - Size Stories .. Units..-,
Arch., Engr: ..... -. ,
Designer New O:. Add ❑ Alter ❑' Repair D. -Demolition ❑-
_ ti
Address Tel.
City Zip State TM—LUS AMWIM
Lic: #
LICENSED CONTRACTOR'$_DDECLARATION
I hereby affirm that I am licensed under provisions of Chapter g1(c6rnencing'with Section.• -
7000) of Division 3 of the Business. and"Professions Code, and'my license is in full force and
effect. l... . r _
SIGNATIIRE3. - ..ikf .�+^.:. DATE .. _ - .. ..
OWNER -BUILDER DECLARATIONEStlrrlated .V11UatlOn
I hereby affirm that I am exempt from the Contractor's, License Law for the following �• 4 �py' -
reason: (Sec. 7031.5,Business and Professions Code::Any city, or. county which requires a s .'
permitto construct, alter, improve, demolish, or repair any structure, prior, loPits issuance also • -AMOUNT' '
requires, the applicant for such permit to file a signed statement. that he Is licensed, pursuant -to PERM IT- • ->
the provisions of the Contractor's 'License Law, Chapter 9 (commencing with Section 7000) o1
Division' 3 of the Business and Professions Code, or_that. he, is exempt therefrom, and the basis' "''Plan, C. Dep.. 'for .the alleged exemption. Any violation of. Section 7031.5 by' 'any 'applicant :for a .permit: p ••
subjects the applicant'to a civil penalty of not more'than five'hundred dollars ($500).• .. -ti�.�� -
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will : , Plan Chk. Bal. , . .
do the work, and the structure is not•intended or offered for sale: (Sec. 7044, Buisness and COnSt. ' s,g�
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' improvements are not intended or offered lor.sale. If, however, the building Mech.
" or. improvement is sold within one year of completion, the -owner -builder will have the burden - • ,EleCtrlCSl
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
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.I. • 450
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 Grading
Driveway Enc.
Date owner Infrastructure
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have a certificate of 'consent toself-insure, or - a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800; Labor Code.) -
Policy No: Company
. ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.' .
TOTAL 49.17
CERTIFICATE OF EXEMPTION FROMREMARKS
WORKERS' COMPENSATION INSURANCE. `3' ' '•�
(This section need not be completed if the permit is for one hundred dollars ($100) evaluation - - - or less.)
I certify that in the performance of thg work for which this permit is issued, I -shall not •" ix. • -
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 ZONE: ° BY:- - -
'subject to the 'Workers" Compensation -provisions -of the Labor Code, you 'must forthwith _ ,MiflifTlll.m 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 Lin
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
This is a building permit when properly filled out, signed and validated; and is'subject to .FINAL DATE' INSPECTOR `
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that'the above information' is correct: ISSued'by: Date 746.Perm'it
agree to comply with all 'city and county ordinances and state laws,telating to building '
construction, and -hereby authorize representatives -0V this city to enter the •above-. "
mentioned property for inspection purposes. fr Validated by:
Signature of applicant ate
Mailing Address Validation: !
,City, State, Zip
A62.53_..._..8 s28 49,17 CK
HARD COPY -
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
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
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
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.
SQ. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.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. 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
Z 3
/�
cr
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$
c$
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
u
CERT. OCC.
FENCE FINAL
IUH'S SIGNA I UHESIINITIALS
GARDEN WALL FINAL
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