09389 (RR)•.
Building
Address G1..
Mailing
Address P• 0e Box 4136
City Zip
Contractor
Address
CityZip
..—.na, 92201
State Lic--
& Classif. C39 274921
Arch.; Engr.,
Designer,
Address
el.
P.O. BOX .1504 %� r N 0 .
78-105 CALLE ESTADO { .
LA QUINTA, CALIFORNIA 92253:/
(j f
�
BUILDING:.�TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description
345-3751.
City
Lic. #.
Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that lam 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
a eSfN., .41? . P
:SI N'ATUR R ATE
i OWNER•BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec.. 7031.5,Business and Professions Code: Any city or county which requires a
09389
Re --Roof
Sq. -Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ ^'� Repair ❑ Demolition ❑
Estimated Valuation
2x640.00
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
PERMIT
.AMOUNT
the, pro visions. of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he Is exempt therefrom, and the basis
for Section 7031.5 'any for
Plan Chk; Dep.
the alleged exemption. -Any violation of by 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 able compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
5' �_ 00
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,-
Mech.
provided that such.dmprovements 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 -
Electrical
of proving that. he did not build or improve for the purpose of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing .
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
S.M.I.
- such projects with a contractor(s) licensed pursuant to the Contractor's License -Law.)
Grading
.21
0 1 am exempt under Sec.=B. & P.C. for this reason
Driveway Enc.
Date owner•
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. ❑ Certified copy is hereby furnished.
%
TOTAL
.1
-'
CERTIFICATE OF EXEMPTION FROM.
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if 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 peon in any manner so as to become subject to the Workers' Compensation
Laws of Californirsa.
Date Owner
,- NOTICE TO APPLICANT: It, 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 if work thereunder is suspended for 180 days.. .
I certify that I have read this application and state; that the above information is correct.
Issued by:
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 the above-.
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT.
YARD SPKLR SYSTEM
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SO, FT, ®
SEWER OR SEPTIC TANK
GAR. SO, FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
DRAINAGE PIPING
CAR P. SO. FT. ®
HEATING (FINAL)
OTHER APP./EOUIP.
WALL SO. FT.
DRINKING FOUNTAIN.
SO FT ®
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
FINAL INSP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
FIREPLACE
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ec
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
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
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
FINAL INSPECTION 7 /*
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL