002399 (RPL)Building
552-051 AVellida
Address
City.
Owner
Tela .
ai4 Qk*1in
Mailing
Address
moi'
CityZip
State Lic.
City
1A C
92.253
Contractor
Sq. Ft.
Address
P.O. BOX 1504 No, UU239!j
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST: OCC: GRP.
A.P. Number
Legal Description
Project Description
. 28 R .14 1o1
City.
Zip .-
Tela .
State Lic.
City
& Classif.
Lic. #
Sq. Ft.
No. No. Dw.
Size -
Stories- Units
Arch., Engr., -
Designer
New jX Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. # ..
MINIMUM
5 FT. HIGH FECK-C-
_ LICENSED CONTRACTOR'S.DECLARATION, ...LF
ALL
~
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
I AND SEI
E-1 ATCHING-
r
.effect. .
SIGNATURE DATE
,
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following.
$. 4l2j}
00
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
1/ V0
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 thal.he is.licensed pursuant to
-
PERMIT
AMOUNT -
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of.
Dh4sion 3.07 the Business and Professions Code, or that. he is ekempt therefrom, and the basis
for the Any Section 7031.5 -by 'any for
-
Plan Chk:. Deo.
..
alleged exemption. violation of applicant. a permit -
' subjects the applicant to a civil -penalty of not more than five hundred dollars ($500). -
Plan Chk. Bal.
C.c
5&
O I, as owner of the property, or my employees with wages as their sole compensation, will
•42 ,
do the work, a
and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
Professions Code: The Contractor's License -Law does not apply_ to an owner o/ property who
-
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 o/ completion, the owner -builder will have, the burden
Electrical
- 70.00o/
proving that he did not build or improv -e for.lhe purpose of sale.) -
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
s�
12.00
• struct the project. (Sec. 7044, Business and Professions Cotler The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who for
S.M.I.
_contracts
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) r ` "t
0 1 am exempt under Sec. B. & P.C. for this reason
Grading
?
Driveway. Enc.
Date / - I" 411_Owner 'l �" t. �- *
Infrastructure
WORKERS' COMPENSATION DECLARATION
Ihereby 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. O Certified copy is hereby furnished:
TOTAL
163.52
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i/ 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 '
I 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
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:'
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.
I that I have
A
`2¢'
certify read this application and state that the above information is correct.'
-Issued by:
Date Permit
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-
for inspection'purposes. /
-
mentioned property
Validated by:
Signature of applicant '� Date
_
Mailing Address
Validation:
City, State, Zip
A5775
6 11 163.52 CK
HARD COPY
t
T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
R UGH PLUMB. 8
BONDING '%
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
WALL SQ. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
SQ. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
-$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ®11/4 C
SEWAGE DISPOSAL
SQ.FT.GAR Q 3/4c
HOUSE SEWER
FINISH GRADING
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
R UGH PLUMB. 8
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 6 6
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
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