08640 (RPL)Building
Address
Owner
Mailing
Address
City
ntractor,
State Lic..
& Classif.
Arch., Engr.,
Designer
P.O. BOX 1504 ' . N o . 08640
78-105 CALLE ESTADO f
55 Ave. eeLwco LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.-
65'
RP.6S' Ave. Ve2"co A.P. Number
Zip Tel:
92253 5164—M18 Legal Description
Project Description Po6i is 'Son
Zip Tel
City
Lic. # Sq. Ft. 366 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑
Address
Tel.
Side Street Setback from Center Line
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Seo. 3097, Civil Code.)
-
City
Zip
State
Lender's Address
Lic. #
INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
LICENSED CONTRACTOR'S DECLARATION'
expiration it work thereunder is suspended for 180 days.
I hereby affirm that I am.lice sn ed 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
I certify that I have read this application and state that the above information is correct.
effect. P •�
- Date Permit
I agree to comply with all city and county ordinances and state laws relating to building.
SIGNATURE "'�.*..+"'"•'", _"' .' "` ."'-". .. "_ "�-•' DATE
..
construction, and hereby authorize representatives of this city to enter the above-.
OWNER -BUILDER DECLARATION
Estimated Valuation
- mentioned property for inspection purposes.
I hereby affirm that I am exempt from the Contractor's License Law for the following
A
Signature of applicant Date
reason: (Sec. 7031.5,8usiness and Professions Code: Any city or county which requires a
. permit to construct, alter, improve, demolish, or repair any structure, prior to. its issuance also
requires the applicant.for suchpermitto file *a signed statement that he is licensed pursuant to
PERMIT
AMOUNT
'. the provisions of the Contractor's License Law, Chapter 9 (commencing, with Section 7000) of
' City, State, Zip
' Division 3-"ol the Business and Professions Code, or that. he is exempt therefrom, and the basis
for Any Section 7031.5
,
Plan Chk. Dep.
'
the: alleged exemption. violation of by any applicant for a permit
subjects the applicant to a civil penalty of not more than live hundred dollars ($500).
Plan Chk. a.
Bal.
-
�
;;. O I, as owner of the property,. or my employees with wages as their sole compensation, will
-,(:`ydo 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 improves thereon and who does such work himself or through his own employees, .v
Mech.
' provided that'•such Improvements are not intended or offered for sale. If, however, the building24.
- 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
strucl 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
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner.
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, tabor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL g A IQ
CERTIFICATE OF EXEMPTION FROM
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 the 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
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such piovisions or this permit shall be deemed revoked.
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Seo. 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 it 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
i Mailing Address
Validation:
' City, State, Zip
'
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SO. FT.
SEWER OR SEPTIC TANK
ROUGH WIRING.
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
GAS (ROUGH)
METER LOOP
DRAINAGE PIPING
CARP. SQ. FT. @
REINF. STEEL
GAS (FINAL)
TEMP. POLE
DRINKING FOUNTAIN.
WALL SO. FT.
GROUT
WATER HEATER
URINAL
SO. FT. @
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
LUMBER GR.
WATER SOFTENER
VENT SYSTEM' FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
MESH
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
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION 0
GGG
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATIriiES11NITIALS
GARDEN WALL FINAL