002855 (BLCK)P.O. BOX 1504
78-105 CALLE ESTADO
Address '7 LA QUINTA, CALIFORNIA 92253
Owner
MrU t asw
Mailing
Address
City Zip Tel.
Contractor
Address
IZip
State Lic.
& Classif.
Arch:, Engr.,
Designer '
Address
Tela
City
Lic. #
Tel.
BUILDING: TYPE CONST. OCC,. -GRP..,,.
A.P. Number
623 Legal Description
Project Description
�Sq eFt 2 -"11� ftStories UnitDw.
New OA Add ❑ Alter -0 Repair ❑
-Demolition 0
City
Zip
State
f3—lwt. ':'"+acp r
_
Lic. #'
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
EStirnated Valuation.
_
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 county which requires a
t �i
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 hw is licensed pursuant to
... PERMIT
AMOUNT
the provisions of the Contractor's License Law, Chapter. -9 (commencing with Section 7000) of
Ll
' Division 3'of the Business and'Professions Code, or that. he is' exempt therefrom, and the basis
for the Any Section 7031.5 'any for 'a 'permit
'Plan 'Chk. Dep. -
-
alleged exemption. violation of .by .applicant
subjects the applicant We civil penally of not more than five hundred'dollars'(S500).
Plan Chk..13a1.
20.15do
. ❑ I, as, owner of the property, or my, employees with wages as their sole,,compensation;,will
-the
tfie work, and structure is not intended or offered for sale. (Sec. 7044, Buisness and.-
COhSt�.
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 improvements are, not intended or -offered.lor 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.)
❑ 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.1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
-Sec.
Grading
D.1 am exempt under B.•& P.C. for this reason
p,
Driveway Enc.
Date OwnerV 4 )If.x frs•.-tii.'•c>
Infrastructure
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
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for' one hundred dollars (S100) valuation
or less.) ._ ... .. .. ..
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, 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
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
Lenders 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 this
�'.�
read 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 applDate'
Mailing Addres
Validation:
City, State, Zip
A% 1 I 1
1 26 5 1. 6 5 U
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
I ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP.IEQUIP.
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
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, TEMIPERM
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 ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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
O MS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
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.
�41FENCE FINAL A
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL