09321 (PLBG)Building
Zip
& Classif.
P.O. BOX 1504 N o . 0-9321
78-105 CALLE EST'ADO
LA,QUINTA; CALIFORNIA 92253
BUILDING:, TYPE CONST. OCC: GRP'
A.P. Number
Tel. ..
Legal. Description .
Project Description
4
City ( Zip ( State
Lic. #
LICENSED.CONTRACTOR'S DECLARATION.
('hereby affirm that.l am licensed under provisions of Chapter 9 (commencing with Section.
:6 ) ofDivlslon,3 of the Business: and Professions Code, and myticense is in,fulfforce and
effect.;"•
91GNATHRE _ - - - :+. -__ - _. _ •.. .. - - 517E
c -
I am exempt from
Sq. Ft. No. No. Dw.
Size - Stories Units
New ❑ Add ❑ Alter❑; Repair ❑ Demolition
for the following. Estimated Valuation
which requires a
�parrnn m conauucr, erter„[mp[ove, cemonsn, or repayany s[ruc[ure,, poor [o ils,lasuance also,
requ/res-the_appik:ent;lpr sucA..permR to R/e a'algned statement:that Ae !s Ikensed pursuant. to
,,,.•she' provlstons o► the Contractors License Law, Chapler 9.(commencing wlfh Sectlorr_70001 0/
Oivlalon 9 0/ the BusMess and Pro/esslons Code, or,tiiat.he /s exempt therefrom, and the be
sis-
lor the alleged -exemption: Any vlolatkm o/ Section 7031.5 by any applicant for a permit
subjects,the.app/leant los crvti penalty of notmorethanNve hundred dollars (5500).
❑.I, as ownerof,'the property, or my^employees wlfh wages asaheir sole,compensation; Willi
do the work; and the structure is not -Intended or' offered for'sale, (Seq. 7044; &ilsness and.
.Pro/esalorrs' Code TAe Contractor's•,L/oense Lew, doesriot apply to an ownero/ property Who
bulled§ or hnprovea thereon .and who does such .Wolk hlmselt ,orthriough his own. er�Myees,
provided that suoh Improvements .are. not; Intended or offered /or: aale. 1f;. however, .the^ building.
or improvement is sold within one year of completion, the owner-buider, will have the burden
or proving that he did not: -build or-knprove /or the purpose of sale:)
O 1, as;owner of :the property, am^exclusively,contracting with licensed contractors to,_coni
struct the project. (Sec. 7044, Suslness;end Protesslon's;Code: The Contractors License Law
does not. apply to an -owner of property 'Who .builds oramproves •hereon, and irho,contiacts I&
such projectsmith a cantractor(s)'Ikensed,purauantto the :�Contractor's License, Law.)
❑ .I,am exempt,under Sec: R. B P.C., for thisireason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby, affirm that I have a; certificate of consent, to self -Insure, ,or a certificate of
Worker's'Compeneatlon`Insurance;,or'a certified copy thereof. "(Sec.3800, Labor Code.)
P61 icy; No. Company
❑ 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 (5100) valuation
or.less`) - - -
I certify that In the performance•of the work for which.this permit is issued, l shall not
employ any person'.Irrany mrannerso.as to become subject to:the Workers' Compensation'
Laws of Califfornia
Date _Owner
NOTICE TO APPLICANT:. ti; alter. making this Certificate. o/ Exemption you should -become
subject to: the Workers' 'Compensallori provisions of the 'Labor Code. - you must loifhwllh
comply'whA'auch,provisions or lh/a peimitshall.” deemed revoked..
CONSTRUCTION LENDING'AGENCy
I hereby affirm that there, lsra construction lending agency forthe performance of the
work,focwhich this permIt,is;issued. (Sec: 30.87, CIvflCoii6J .
Lender's Name
Le_n_ does Address
This is a,building, permit when properly filled out, slgned,and validated, and'is subject to
expiration if workthereunder Is,suspended for 180 days.
1 certify that I have,read•,this`application _and,state thatthe'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 properly for Inspection purposes.
Signature.of applicant Date•_
Mailing Address
City, State, Zip
PERMIT'
Plan Ch.k. Dep.
Plan, Chk. 'Bal.
Const.
Mech.
Electrical
Plumbing.
Driveway Enc.
Infrastructure
REMARKS
k 71( t -=}I -91
ZONE- -BY:
Minimum Setback Distances:
Front Setback from;Center Line
Rear•Setback from Rear Prop: iLine
Side Street'Setback•fTom Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR''
Issued by Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES.
NO., PLUMBING FEES.
1ST FL. SQ. FT.,® $
UNITS _
SLAB GRADE',
ROUGH PLUMB.
BONDING
YARD:SPKLR SYSTEM
2ND FL. SO. FT. @
FORMS
SEWER OR SEPTIC TANK
FOR., SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR.SQ .FT. ®
POWER.OUTLET
ROOF DRAINS,
HEATING (FINAL)
OTHER APPJEQUIP.
jDRAINAGE PIPING
CAR P. SO. FT..®.
TEMP. POLE
WALL -SQ: FT: 0 .
GROUT
DRINKING.FOUNTAIN.
SO. FT. ®
FINAL.INSP..
URINAL
ESTIMATED CONSTRUCTION VALUATION E
WATER'SYSTEM
WATER PIPING
NOTE:.Not to be; used as property tax valuation.
=_
FLOOR'DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH).
APPLIANCE DRYER
REMARKS!
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR, SUSPENDED
01
LAUNDRY TRAY -
AIR HANDLING UNIT CFM
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
SO. FT.. ® c
WATER HEATER
MAX. HEATER OUTPUT, B:T.U.
SO.;FT. RESID @ 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 36c
HOUSE SEWER
FINISH GRADING
GAS PIPING
PERMIT FEE
PERMITTEE,
PERMIT FEE'
DSL
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 APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE.
FINAL.INSP..
BOND'BEAM
WATER'SYSTEM
GRADING'
cu.,yd.
6 plus xi
=_
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS!
VENTILATION
01
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