08166 (BLCK)TAtyl
P.O. BOX 1504'' o. 08166
N105
Building '78-105 CALLE ESTADO
52-03I Avenida Velasco LA QUINTA, CALIFORNIA 92253
Address
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OwnerNaX
.
ECe
BUILDING: TYPE CONST.' OCC: GR P:
Mailing-' '�
Address Sam'
A.P, Number '773.._921_012
:.City.
Zip
Tel:
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Legal Description tests I 3 R Tb Is t - ft ton
Contractor
Project Description € .,�� � '-�F--°01
Ion 40+ dram
' Address
137 N. Amhaifian Place
City'
Zip
Tela
State Lic.
City
Classif.
Lic. #
Sq. Ft. No. No. Dw.
R 2M38
1 _AZ38
Size Stories Units•' .
-Arch., Engr.,
',
'_Designer -
New ❑ .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'G of the .BLfginess•and-Professions,_Code,'and my license is in full force and
effect... -.-.r.- •� II
SIGNATURE \- "Ae+�'•^ -"-/DATE
OWNER•BUILDER DECLARATION
ffirm that I am exempt frohe,Contkractor's License Law for the following
II hereby am l
Estimated Valuation
reason: (Sec. 7031.5,Business 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
4requires the applicant for such permit to 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
,the
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 ($500).
Plan Chk. Bal.
❑ I, 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. HAD
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 for sale. If, however, the building
or improvement is sold within one year of completion, the .owner -builder will have the burden -
Electrical
a of proving that he did not build or improve for the purpose of sale.)
. ❑ 1, 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
O 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, Labor Code.)
'Policy No. Company
❑'Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 54.21 1_-
CERTIFICATEOFEXEMPTIONFROM
r/
REMARKS .-'
WORKERS' COMPENSATION INSURANCE
_
(This section need not be completed if the permit is for one hundred dollars (8100) valuation
♦ . d�i.�,, + moi:LT7 �G l: r�� ` • i S i
or less.)
- I certify that in the performance of the work for which this permit is issued, l.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
coNsraucTloN 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
e
/2b/9P
certify that I have read this application and state that the above information is correct.
Issued by: Date Ci ermlt
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
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
A.C. UNIT
2ND FL SQ. FT.
SLAB G?j LEa
YARD SPKLR SYSTEM
FOR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
SEWER OR SEPTIC TANK
DRAINAGE PIPING
WALL SQ. FT.
DUCT WORK
DRINKING FOUNTAIN.
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
REINF. STEEL
FLOOR DRAIN
MECHANICAL FEES
TEMP. POLE
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER HEATER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
ITEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR Hp
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SQ. FT. ® c
BATH TUB
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SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FIRE ZONE ROOFING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
1
MICRO FEE
1 1
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK �� �Q
All;
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB G?j LEa
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 O
FINAL INSP.
ROOFING
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REMARKS:
t7a�
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND ! 0
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL