001600 (BLCK)TJ
Building
Address
Owner
Address P.O. DO.
City
La icc ��.�
nti
Contractor
+lim
v. Address ...
4
P.O. BOX 1504
78-105 CALLE ESTADO, -
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
a24A.P. Number
Zip Tel. _
.92M Legal Description
Project -Description
• _ . � 'a x142 ,r+� � f�� - uxnni�r - . '.
City Zi
State Lic.
& Classif.
Arch., Engr.;
Designer
Tela
City
Lic. #
Sq. Ft. No. No. Dw.
Size Stories Units
New Eir -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
7000) of Division 3 of the Business and Professions Code, and my license is in -full force and
effect.
_SIGNATURE DATE
OWNER -BUILDER DECLARATION
' 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
permit to construct, alter, improve, demolish, or rehab any' structure, prior to "its issuance also
• requires the applicant.for such permit to rile a signed .statement that he is.licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9'(commencing with Section 7000) or
' Division 3 "of the Business and Professions Code, or that. ne is exempt therefrom, and 'the. -basis-
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500):'
O I, as owner of the property, or my employees with wages as their sole compensation, will .
Estimated Valuation
r. q� qy
*a' .6,. .00
,
• _ < _
--PERMIT ...AMOUNT
•+
'
Plan -Chk> "Dep. -
Plan Chk. Bal.'
Const. e 50
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 workhimself or.through his own employees,
"provided that such improvements are not intended or offered for sale. If,..howevar, the building-
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.)
'Electrical '
Plumbing
O 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
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - -•
O.I am exempt under Sec. .%i & P.C. for -this reason ,'
�/; •.) „ Jp,
Date ' Owner %�rCt #t�
Grading
Driveway Enc.
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.).'
' Pot icy No. Company
• . ❑ Copy is filed with the city. O.Certified copy is hereby furnished.. ..
TOTAL
•
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(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 provisions or this permit shall be deemed revoked. -
BY:
ZONE: BY:
Setback Distances: -
- - - -
Front Setback from Center.Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Lhereby 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 Street Setback from Center Line -
Side Setback from.Pfope.rty Line
Lender's .Name
Lender's Address
' 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.
-FINAL.DATE INSPECTOR
I certify that I have read this application and state that the above information is correct.ISSUed
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- f, [{
Signature of applicant �/ ?�l !r?r(. r p� �'ti s f 'dL/ts'ate�` ` �+ f
Mailing Address
:!- by: Date Permit
Validated by:
Validation:
City, State, Zi
A 1 8 5 1 7 8 54.1.2 CK
e'
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT. p
YARD SPKLR SYSTEM
POR. SQ. FT. p
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DUCT WORK
DRAINAGE PIPING
WALL SO. FT.
DRINKING FOUNTAIN
SQ. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
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
GRADING
cu. yd.
$ -plus-x$_=$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IKITCHEN 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
FIREPLACE
SQ.FT.GAR ® 3/ac
HOUSE SEWER
SPARK ARRESTOR
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 APPJEQUIP.
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
I N SU LATIONISOU N D
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
ENCE FINAL I I '
J
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL