04773 (RPL)'i'\ply}
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P.O. BOX 1504
.. 3
Buildingr""79 78-105 CALLE ESTADO
Address ; �i'�,f��TCS�. d LA QUINTA, CALIFORNIA 92253
Owner
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yMailing
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BUILDING: TYPE CONST. - OCC. GRP.
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Address 75-005 C'4�l'Eiitry c
VGA West Phases
.ab � . x .. ..
A.P. Number . ; _
.7
City Zip Tel.
ptlillC3 Dellsort 92260 568_48,�
Legal Description
?
Contractor
Project Description 1 0 amp 'pool pedestal
4 y. t� a
National
ITIR�.ir-3J��.k :�1i��W�"ii —
.Address
Sam
City , , ., Zip Tel.
State Lic.
City
& Classif.
Lic. #
Sq. Ft. "
No. No. Dw.,
Size
Stories Units
Arch., Engr.,.
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
:,
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
f 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and
effect� .'•;r`.��. r.y :, .4.. .:orf
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SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby that I from the Contractor's License Law for the following
Estimated Valuation
A
'°'riJ*"'
affirm am exempt
reason: •(Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a
PERMIT
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`AMOUNT
permit to construct, after, 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 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis
Section 7031.5 by 'any for
Plan Chk. Dep.
,
for the alleged exemption. Any violation of applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
Plan Chk. Bal.
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
Const.
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
Mech.
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. If, however, the building
Electrical -
_
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.) .
0 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
builds Improves thereon, for
S. M. 1.
does not apply to an owner of property who or and who contracts
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
,
-
Date Owner
Infrastructure
a
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.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
x1
(This section need not be completed if the permit Is for one hundred dollars ($100) valuation
,�e.r� y R}+"S� ,AA,,�F
.-a•'i�x�7 #L(�7[�q $
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
- NOTICE TO APPLICANT., If, alter making this Certificate of Exemption you should become
ZONE:
BY:
• subject to the Workers' Compensation provisions or 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 if work thereunder is suspended for 180 days.
�
1 7 i 8 ",.
1147/88
17
I certify that I have read this application and state that the above information Is correct.
Issued by:
i
Date Permit \ -
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 theabove•
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date
Mailing Address
Validation: r i .
;
GOLDENROD - ASSESSORS OFFICE, HARD COPY - FILE : ; 4
' City, State, ,Zip
WHITE - FINANCE PINK APPLICANT GREEN - BUILDING,
, s.. [ ,.-.z'a3 a e..:'.ts: «. . C: �«: �- .. as'.•'.... ;.�G� '•es."' -.'s.• i' `. �- •-- . - *� .o ':�'^.=,�t.� -
� ... _ ... ... - . ,. _ .';F, ...
.. ..... ... ....._...... . -'s ,er �� °�t..� '� _ .. e ... ,. � K�_--_.
CONSTRUCTION ESTIMATL
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT y $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB
YARD SPKLR SYSTEM
2ND FL SO FT. a
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR SO FT. a
ROCK STORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR SO. FT. *
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SO FT. a
GROUT
WATER HEATER
DRINKING FOUNTAIN
WALL SO. FT. Q
BOND BEAM
WATER SYSTEM
URINAL
SO. FT. Ai
-
x$ =$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
I WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTOXDISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE. UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIREPLACE
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 g 1% c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/:c
HOUSE SEWER
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 APP.IEOUIP.
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR,
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FSI N C N
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL