002929 (BLCK). , 1
44a
�cu
S/ff-O P.O. BOX 1504 No. .002929
Buildingw ,�� 78-105 CALLE ESTADO
Address B'�''"=�= LA QUINTA, CALIFORNIA 92253
Owner
Mailing _ . BUILDING: TYPE CONST. OCC: GRP.
Address A.P. Number -76
City La. Qua Zip Tel. .
ipt?�22.rJ� _ Legal Description
Contractor Project Description
Address.
f�Ctk .. i.c3h Madill: U a n
City lZio Tel.
State Lic. City
& Classif. Lic. #
Arch., Engr.;
Sq. Ft.�
Size- a
No. No. Dw.
ftstories- Units
New O Add ❑
Alter ❑ Repair ❑ Demolition ❑
Designer.
Address
Tel.
City
Zip
State
Lic.
M
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
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 oounty 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
the provisions of the Contractor's License Law, Chapter 9 (commencine with Section 7000) of
Division 3 of the Business and Professions Code, or thathe is exempt 'herefrom,•:and-the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for -a permit
subjects the applicant to a civil penalty of not more than five hundred dollars :1500).
❑ I, as owner of the • property, or my employees with wages as their ;ole compensation, will
do the work, and the structure is not 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 or improves thereon and who does such work himself or through his own employees,.
provided that such Improvements are not intended or offered for sale. .r, however, the, building
Estimated ValUatlOn
j �6.7�C�Q�
Y
PERMIT
..
AMOUNT
Plan Chk. Dep.
- -
Plan Chk. Bal.
17.22
Cont.
��
Mech. -
-
'
or improvement is sold within one year of completion, the owner-buildar will -have the burdenElectrical
. of proving that he did not build or improve for the purpose of sale.) ..
Plumbing
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
slruct 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 contractors) licensed pursuant to the Contractor's Licerse Law.) - -
. O I am exempt under Sec..B. B. 8 P.C. for this reason
- S.M.I.
.50-
Grading
Driveway Enc.
Date 'Owner ?- - %- �. f
F-
Infrastructure
}A
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have' a certificate of consent to self-insare,'or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3300, Labor Code.)
Policy No. ' . Company
0 Copy,is filed with the city. ,❑ Certified copy is hereby furnished.
TOTAL
44,22
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed if the permit is for one hundred Iollars ($100) valuation
or less.) - - - -
I certify that in the performance of the work for which this permi- is issued, I shall not
employ any person in any manner so as to become subject to the W irkers' Compensation
Laws of California.
' Date Owrier '
NOTICE TO APPLICANT: If, after making this Certificate of Exemptioe 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.
ZONE: BY: '
Minimum Setback Distances: `
•
Front Setback.from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
FINAL DATE
-issued by:
Validated by:
Validation:
Side Street Setback from Center Line
Side Setback from Property Line
INSPECTOR
Date 2 13 - Permit
Lender's Address
' This is a building permit when properly filled out, signed and validat:d, 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 r ate
Mailing Address f
City, State, Zip t
A7320 2 13 44,22 R
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT..® $
2ND FL. SQ. FT.
POR. SQ. FT. p
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
n
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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
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.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
n
-
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
GARDEN WALL FINAL
INSPECTO SIGNATURES/INITIALS
e / Please Rou r/ v� _ POg� ~roufln0
request
FEB EAS Li Rc^,IcSTaaa'L7`q C �K V C
12 198
^rTi of HANpLE To
=OM,y�UN17yCiFVEiJ `E,Y a V
an
APpq� E
city planof La WEN
10� Director FORWARD
qu_1nta� C for ❑ RETuRN
nia 92253 I&KEEp
Planning Director;
I f ❑REVIEW WITa -'H`'�
I m ,e ing this t pate ME
have recent letter on
around my reSi ap`)lied fora°vise of the From
under question disc oble olocated t b e di 4e errtit �o g COU, r,,�r�.
k wall
Thefront Yard of address cons uct a bloc
(6de el Ped road is uriiqua residence° Mall to be constructed )foot d
construct unless hoe tis �ccorciin tousu� due to
traffic.ton to COnsidere C1ty pr lObistic of
three (3) foot because to be On ad ode wa]ls are J_i ."dajaCent
The aus u rner whit "sited to six
e of vis � �-�-tat t h emits
problem is
constitutes it due to this undeVelo ins for vehicular
This road in as being a Corner lot°d dirt road and speck
three (3) Ire question has is 1f this
local ne' �-rum
ATC ve.li�IhborhoodsPto bry°_ It,,
mere of vebicular
friends° es' Ihich ax'e a1 o seeIf cs ldrrensoterstoeen fortrafs us e esideIc npro�matelY
ce of
f oion to erect t safety hazard to Zr f� yrbi es and
abatement -9 Property vhis wall at a 3i d visiting
nt of noise (Inc, uationP security (6) foot height
ti�isurvey has been cond 1 urY0 Y, cosmetic Woulappearance serve several
ad were to
uctecl t d certailly
Construction
struction of be developed ImPairement of
pro sial vehicul
problem° h� s w at it for vehicle tra f f- -'Ir traffic
posed wall co Attached is a s s requested he f1C by my selfin the event
nstructi° ketch of lght and pertIota through obse
cL
ork�s inpreciate a ire ia n for
You consideratio v and surrounding °uld cause no
1On�
ful1fi11 this Progressrequirement � te � rmit answer
'Issuance, to this request
P opert1es and
' Ind nce
aPPrecia a yur, inn if a1vazi.Pre Lund, lay out
Put, is necessary to
aP�to Ac,QIEA(94E-
VAI 4)
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