08903 (BLCK)Building
Address
T4ht 4'4 Q,"
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Address
City Zip Tel.
Contractor
ress
& Classif. 257670 I Lic.4
Arch., _Engr i
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S.DECLARATION'
I herebyy fflghAat I amilcensed' no s otCb80tar ommencing with Section .
700 ,f'Divisi 3 of the Busi a` rofessions Cpd mv. license Win full force -and
OWNER -BUILDER DECLARATION
I hereby affirm thatA am exempt from the Contractor's License Law for the following
reason: (Sec.. 7034. 5, Business and Professions Code: Any city or county which requires a
permit to construct, atter, 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
'the-provlsions bf ithe. Contractor's License Law, Chapter 9 (commencing. with Section 7000) of
Division 3,of.theAusiness 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
subjects this applicant to a,614,penalty of not more than. five hundred dollars ($500).
❑ i; as ownenof the;property; or my employees with wages as their sole compensation; will
do the work, and _the structure isnot intended or offered for sale. (Sec. 7044, Buisness and
Professions .Code: The Contractor's License Law does not apply to an owner of property who
builds of improves 'thereon and who does, such work himself- or through his own employees,
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
of proving that -he did not build or Improve for the purpose of sale.)
❑ I,.as owrier'of th p- perty, am exclusively contracting with licensed contractors to con-
struct the project,( c: 7044, Business and Professions Code:. The Contractor's License Law
does not apply'to a owner of property wh ids or improves thereon,. and who contracts for
such, pro)e wkh . tractor(s) Ifcensed u t to the Contractor's License LawJ
❑ 1 am Oempt der'seo _� 'Z- R" & P.C. for this Mason
Date
WORKERS' COMPENSATION DECLARATION
I hereby affirrn that I have a certificate of consent to self -insure, ora certificate of.
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800,.Labor Code.)
_ Policy No.- ' Company
"'- El Copy is filed with the city. ❑ Certified copyis hereby fumished..
CERTIFICATE -OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This, section need'not be completed If the permit is for one hundred dollars- ($100) valuation
or fess.)
I certify that`in the performance of the work for which this permit is Issued, I shall! not
employ any pparson In'any manner so.as.to become subject to the Workers' Compensation
Laws of'Calftornia.
Date owner
NOTICE TO .APPLICANT. H; after making this CBrtiflcale of Exemption you should become
subject to the Workers' 'Compensation provisions of the Labor Code; you must forthwith.
Comply with such, p[ovlslons Or, this permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
workfor which;this permit is issued. (Sec. 3097, Civil,Code.)
Lender's Name
Lender's Address
This is -a building permitwhen properly filled out,.slgned and validated, and Is subject to
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.
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.
Signature of applicant Date
Melling Address
City, -State, Zip
77
BUILDING: TYPE CONST. WAI OCC: GRP.
A.P. Number.
I
Legal Description
i
Project Description 97 E'E rza Fm. ai ou wAi 1
Sq. Ft. No. No. Dw.
Size- Stories Units
New ❑ Add. ❑' Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
TOTAL
ZONE:----.;-
BY:
Minimum_ Setback Distances:
Front Setback from Center'Line
Rear Setback from Reai 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
COLL, AREA
2ND FL. SO. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SD, FT, ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. @
ROCK STORAGE
DRAINAGE PIPING
WALL SO. FT. @
DRINKING FOUNTAIN,
SO FT ®
OTHER APPJEOUIP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used.as property tax valuation
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
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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 Vi cSEWAGE
DISPOSAL
SO.FT.GAR ® 3/4cRELECT.FEE
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. 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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd..
$ -plus-x$-=$-
lusx$=$ROOFING
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
/
✓
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,REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR, FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL