003162 (MISC)• ��
P.O. BOX 1504 No. 003162
Building 78-105 CALLE ESTADO
Address 78-042 Cane #jit?rte LA QUINTA, CALIFORNIA 92253
Owner
Antics Xaliarode •:
Mailing BUILDING: TYPE CONST: OCC: GRP.
Address A.P. Number 769"020""014
City Zip Tel.
Le Qiinta.- 922,53 • Legal Description"
Contractor Project Description Plewa Interior. -Wall
�l� Kertnee� �
Address
77--350 Axroba
City. Zip Tel." _
TA Quinta 12253 554-'-2747
State Lic. City
& Classif.. 442118 Lic. # 469 Sq. Ft. No. No. Dw.
Size Stories -" Units -
Arch., Engr.., .
Designer New ❑ Add Q Alter ❑' Repair ❑ Demolition ❑
x
Address Tel.
City Zip State
_ . Lic. #
LICENSED CONTRACTOR'S DECLARATION
I 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 Valuation
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 PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of. •T
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 a civil penalty of not'more than five'hundred dollars ($500).'
❑ I, as owner of the property, or my employees with wages As their sole compensation, will Plan Chk. Bal. 41 40.62
do the work, and the structure is not intended or offered for sale. (Sec:�7044, Buisness and COr1St�}
Professions Code: The Contractor's License Law does not apply to an owner of, property, who Const..,* '
2.50
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 .
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- Plumbingj�
struct the project. .(Sec. 7044, Business and -Professions Code: The Contractor's License Law
does not apply to aorowner of property who builds or improves thereon, and who contracts for S.M.I. '153
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)-
O. I am exempt under Sec. B. & P.C. for this reason Grading
Driveway Enc.
Date 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
❑ Copy,is filed with. the city.. ❑ Certified copy is hereby furnished.
" TOTAL Afq 129.62
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hundred dollars ($900) valuation
or less.) p P
I certify that in the performance of the work for which -this permit is issued, I shall not - 05'MA c (65$._0/5-17-87 _
—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 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 Li rle
1 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 if work thereunder is suspended for 180 days; - .. �?d 2 /,
I certify that I have read this application and state that the above information is correct. Issued by: Date Permit
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 for inspection purposes. Validated by:
Signature of applicant —Date—
Mailing
ateMailing Address Validation:
City, State, Zip .
HARD COPY
T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. @ $
2ND FL. SQ. FT. @
POR. SQ. FT. @
GAR. SQ. FT. @
CAR P. Q. 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 (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)
LAUNDRY TRAY
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.
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.
SO.FT.GAR @ 3/4c
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
/ �rJ
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 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
/ �rJ
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 :d