001911 (BLCK)P.O. BOX 1504 No. 0.01911
Building 78-105 CALLE ESTADO
Address r,7,_1$k5 rvP'z_ijTA ST LA QUINTA, CALIFORNIA 9225.3
Owner
BUILDING: TYPE CONST. OCC: GRP-
Mailing.
Address 52,,,1$5 AmanI vel A.P. Number
City Zip Tel.
dmtA. 92.2 —3407 Legal Description
Contractor Project Description
..Address ... _ .. ..:.:_
City _. Zip Tel:..
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
_
Size Stories Units,
Arch.; Engr.,
Designer Newt❑ 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 Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the-following 1,275.00
permit
reason: (Sec. 7031.5,Bu5
1ness and Professions Code:.Any city or county .which, requires a V ,
. 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 he is licensed pursuant. to PERMIT' - AMOUNT
the provisions of the Contractor's License Law, Chapter-9 (commencing with Section 7000). of'
Division 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). - - ���
❑ I, as owner of the property,. or my employees with wages.as their sole compensation; will Plan Chk. Bal.
'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 . COnsf. �2, .
00
builds or improves thereon and, who does such work himself or through his own -employees,•Meth: `. - -
provided, that such improvements are not intended or, offered 'for sale. It, -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 .
strut, 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. • iso
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
.. 0I am exempt under Sec.. B: 8 P.C. for .this reason Grading
Driveway Enc.
Date Owner !.-.a. eta. : a.._. Infrastructure
WORKERS' COMPENSATION DECLARATION
I' hereby affirm that 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
O Copy is filed, with the city. -❑ Certified copy is.hereby furnished..
TOTAL 36.80
CERTIFICATE OF EXEMPTION FROM - REMARKS
WORKERS'COMPENSATIONINSURANCE
(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 ` -An cmaitirms nst be met on lettilax
employ any person in any manner sous to become subject to the Workers' Compensation
Laws of California.-r�
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. LEN DING 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
'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 certify that I have read this application and state that -the above'information is correct. r Issued by:. Date^ ` Permit.
' I agree to comply with all city and county ordinances and state laws relating to building I
construction, and hereby. authorize representatives -ofthis city to enter the above-.
mentioned property four inspection purposes. r Validated by:
Signature of applicantzl =7 j . w Date
Mailing Address Validation:
City, State, Zip r _ -
' A 3 4 2 4 11 27 3'680 U
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO, FT. ®
CARP. SO. FT.
WALL SO. FT. ®
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOMESVC.
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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
-
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL - -
INSPECTOR'S SIG NATU RESIIN ITIALS.
GARDI�N WALL FINAA i
'I
F,
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•