05698 (SPIN)P.O. BOX 1504 No. 05698 -
Building 5I-407 'SCO 7&105 CALLE ESTADO a
Address - • LA QUINTA, CALIFORNIA 92253
Owner r..
BRUNO/0"BEWA STMBLT
Mailing Aq ��' •+� BUILDING:'TYPE CONST. - OCC: GRP..
P.O. BOX i642 wN
Address A.P'Number 773-085.023 l'
Cit Zip Tel. w
. ^ . CITY 92235 5!9/.340-74$6, .F Legal Description
Contractor "• Project Description VRML INSPECTION
ref. • �1 -
Address .
State Lic.
& Classif.
Arch., Engr.,
Designer.
Tel.:
City
Lic. #
Sq. Ft. No.
Size Stories
[New ❑ Add ❑ Alter ❑ '
NO. Dw.
Units - -
Repair ❑ = 'Demolition,❑
Address,
Tel.
BY:
. subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions orthis permit shall bedeemed revoked..
.-
Minimum Setback Distances:
i
City
Zip
State
CONSTRUCTION LENDING AGENCY
1,
Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
Lic: #
-
,
- work for which this permit is issued. (Sec. 3097, Ciel Code.) ••
LICENSED. CONTRACTOR'S DECLARATION
Side Setback from Property Line '
Lender's Name
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
)
Lenders Address
effect.
INSPECTOR
.
j 89
' 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.
SIGNATURE DATE
Issued by:
"
" OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
1
_ reason: (Sed. - 7031.5,8usiness and Professions Code: Any city or county which requires a
Validated by:
' 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 hers licensed pursuant to
PERMIT -
AMOUNT
the provrsans of the Contractor's license taw, 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 the alleged exemption. Any violation of -Section 7031.5 by 'any applicant for a permit
Plan Chk.-Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars (5500).
-
Plan Chk. Bal.
O 1, as owner of the property, or my employees with wages as their sole compensation, will
do the work, 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 of property who
builds or irtproves thereon and who does such work himself or through his own employees,
Mech. ••
-•
provided that' such improvements are not intended or offered for sale. H, 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 safe.)
O I, as owner of the property, am exclusively contracting with licensed contactors to con-
'
Plumbing
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
. does not appy to an owner of property who builds or improves thereon, and who contracts for
S.M.1.
_
• such projects with a contractor(s) licensed pursuant to the Contractor's License law.)
Grading
r; .
❑ 1 am exempt under Sec B. & P.C. for this reason
Driveway Enc.
'`'-' %
Infrastructure
Date +'• owners ..''e _ ."., .
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
.r
TOTALi'.°
P
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(7his section need not be completed if the permit is for one hundred dollars (5100) valuation
or less.) - - .
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Ow
REMARKS z�=1M"4FE e'ffi� cw +rte %ni
r
NOTICE TO APPLICANT ff, after making this Cerlifx;ate of Exemption you should become
ZONE:
BY:
. subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions orthis permit shall bedeemed 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, Ciel Code.) ••
Side Setback from Property Line '
Lender's Name
)
Lenders Address
FINAL DATE
•
INSPECTOR
.
j 89
' 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
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. S0. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SO. FT.
=$
LUMBER GR.
FINAL INSP.
URINAL
SO FT ®
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIREPLACE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.Ff.GAR ® 3/ac
HOUSE SEWER
CERT. OCC.
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 APPJEOUIP.
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
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
t