09325 (PLBG)ing
Address
City Zip Tel.
Classif. I Lie. #
'ch., Engr.,
Address Tel.
CityZip State
Lic. #
e Argo..
P.O. BOX 1504 NO. 09325
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING- • TYPE CONST: OCC: GRP.,
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Sectlom
70(10) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
^ SIGNATURE - f' " ' - " _ - -.. DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,eusiness and Professions Code; Any city or county which requires a
peimtt, to construct; alter, Improve, _demolish, or _repair any structure, pilar to tta issuance also
regal.. the app/leant for such permit to file a signed statement that he Is 'licensed pursuant to
the provisions of the Contractor's License Law, Chapter a (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 .vWatbn of Section 7031.5 by 'any applicant for a permit
subjects -,the applicant to a civil penalty o/ not morethan five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure Is not Intended or offered for sale. (Sec. 7044, Bulsness and
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 hlmsel or through his own employees,
provided that such Improvements are not intended or offered for safe. 11, however, the building
or Improvement is sold within one .year of completion, the owner -bulkier will have the burden
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-
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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec: B. ti P.C. fordhis reason
Date Owner
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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed 11 the permit la for one hundred dollars ($100) valuation
or less.)
I certify that In the performance of the work for which thls.permit is Issued,'I shall not
employ any pparson In any manner.so as to become subject to the Workers' Compensation
Laws of Calif0 hia
fate Owner
NOTICE TO APPLICANT: B, after making ,this. Certificate o1 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.
CONSTRUCTION LENDING AGENCY
Ihereby :affirm that there Is a construction lending agency for the performance of the
work for which this Permit ls issued..(Sec. 3097,, Civil Code.)
Lender's Name
Lenders Address
This Is a building permit when properly filled out, signed and validated, and is.subjectto
expiratiomit work thereunder is -suspended for 180 days.
I certify that I have read this application and state that the above Information is correct.
I agree to complywith 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.
Signature of applicant Date
Mailing Address
City, State, Zip
..Number
31 Description
act Description
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ .Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mach.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL313 00
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation,.
r-�
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO.. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
A.C. UNIT
2ND FL. SO. FT.
SLAB GRADE
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC. -
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®
ROUGH WIRING.
DRAINAGE PIPING
WALL SO. Ff.
DUCT WORK
DRINKING FOUNTAIN.
SO FT ®
GAS (ROUGH)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WA1 ER PIPING
NOTE: Not to be used as property tax valuation
REINF. STEEL
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE' DRYER
SERVICE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
WATER SYSTEM
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
/
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 114 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Ac
HOUSE SEWER
FIRE ZONE ROOFING;
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 GOND: 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 APPJEOUIP.
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
r /
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING;
FIREPLACE
SPARK ARRESTOR
GAR: FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL