002582 (BLCK)P.O. BOX 1504 NO. 00582
Building78-105 CALLE ESTADO
Address 526-101 Ayenlda Velasco LA QUINTA, CALIFORNIA 92253
Owner
inem Fandio
Mailing
Address
CityZip ITel.
� �,
Contractor
Address
BUIL-DING:TYPE CONST. OCG: GRP.
A.P. Number
Legal Description
Project Description
City _ .. _
Zip
Tel.. ,
State Lic,
City
& Classif..
Lic. #
Sq. Ft.
Size 75 1n•
No. No. Dw.
ft!Stories Units
' Arch., Engr:,
'..Designer
New ON Add ❑ Alter ❑ Repair ❑ . 'Demolition ❑
Address
Tel.
75 : .
of 6—i eMt blitires �:e .
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 following3!
. 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,-.pdor to its.issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is ezenrpt-therefrom,• and'the basis.'
for the: alleged exemption. Any violation of Section 7031.5' by 'any applicant fora permit
subjects'the applicant to a civil penalty of not more than Ove. hundred dollars (5500).
O I, as owner of the property, or my employees with wages as their sale compensation, wJII
' 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
Estimated ValUatlOn
�f
•''
PERMIT.- .
, .
- AMOUNT
Plan Chk. Dep..
... -
-
Plan Chk. Bal.
-CionSt.
' 20.00
Mech.
• builds or improvesthereon and who does such work himself. or. through his, own employees,
provided that such. improvements, are not,intended,or offered for sale:.lf, however, 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
.. -
❑.l, as owner of the property, am exclusively contracting with licensed contractors to con-
• 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
• such, projects with a contractor(s) licensed pursuant to the Contractor's.Ucense Law.)
_ ❑ I am exempt under Sec. B. 8 P.C. for this reason
S.M:I.
Grading
Driveway Enc.
-
Date Owner X '. •'
Infrastructure
WORKERS' COMPENSATION DECLARATION
' Thereby 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
20100
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
--
(This section need not be completed if the permit is for one hundred dollars (S 100) valuation
or less.),
I certify that in the performance of tho 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.
n .
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.
.ZONE: -BY:
MIr11r11U.m 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, Civil Code.)
Side Setback from Property Line
Lender's Name
FINAL DATE
Issued by-
Validated by:
Validation:
A63i9'
INSPECTOR
Date •G 4-86Permit
_.
9 14 20.00 Ck
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.!.
I certify that I have read this application and state thatAhe above information is correct.
I agree to comply with all city and county ordinances grid state laws' relating to building
construction, and hereby authorize representatives of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant y Date
Mailing Address'
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO, FT. ®
CARP. SO. FT.
WALL SO. FT. ®
SO. F.T. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROUGH WIRING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAS (ROUGH)
K/CHEN 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
WATER HEATER
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
BOND BEAM
SO.FT.GAR ® 3/ac
HOUSE SEWER
$
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 APP.IEOUIP.
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 SIG NATUFESIINITIALS,
GARDEN WALL FINAL