003431 (PLBG)P.O. BOX 1504 NQ.- 403431
Building 78-105 CALLE ESTADO
Address 52-414' VEW.SCO LA QUINTA, CALIFORNIA 92253
Owner _.
HIS. FW TDA HERNMEZ
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address S&M A.P. Number 773-22'165-008
City ZipTel.
IA Q.0 ® 92253 564-3223 Legal Description
Contractor Project Description SMIC TAM ABANM PLACE.
SAM PLUMS
Address. .
POO. 868
"City '-zip.. Tel.
LA QUINTA 92253 564-11-58-
State
64-11-58State Lic. City
& Classif:.• 0-36 $149 Lic. # . ion Sq. Ft.No. No. Dw.
Size.. Stories Units
Arch:; Engr.,-
Designer. New ❑ Add ❑ Alter ❑, ' Repair ❑' Demolition ❑.
Address Tel.
City Zip State
Lic: #
LICENSED CONTRACTOR'S DECLARATION,
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•inafull force -and
SIGNATURE `!." 3: i' w{ '�../' r C / ✓DATE .. .. .... ..
OWNER•BUILDER DECLARATION ' Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: .(Sec. 7031. S,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 -
requires the applicant /or such pandit 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 x- .
Division 3 oftheBusiness 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 fora 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 COnSt.'� Py(�
Professions Code: The, Contractor's License Law does not apply.to an owner'of property who w
. - 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. /or sale. I/, however, the building
or improvement is sold within one year o/ completion,. the owner-builder'will -have the burden Electrical
-'
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.W.-
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
..O I am exempt under Sec. B. 8 P.C.-for this reason Grading
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
0 Copy is filed with the city. O Certified copy is hereby•fum!shed.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i/ the permit is for one hundred dollars '($100) valuation
or less.). .. ._
I certify that in the performance of thg 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.
TOTAL
REMARKS
. ICAC:' i aS 'LA 'ri-.4.__t•, 4N ..-
Date Owner
. NOTICE TO APPLICANT: I/, 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 '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 it work thereunder is suspended for 180'days.
certify that I have this
MIMI Permit
.I read application and state that .the above information is correct.
'I -agree
Issued by:''
Date
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
,
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1S FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
I
GAR. SO. FT. @
CAR P. SQ. FT.
WALL SQ. FT.
SQ. FT. ®
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
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 APP.IEQUIP.
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
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 SE TI
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
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 SIGNATURESIINITIALS,
GARDEN WALL FINAL
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�-' DIVISION OF ENVIRONMENTAL HEALTH
r'-
t1 Food Establtshmer►t d/Ec.%
Trailer Perls Sewage 616005oi 7�r
Motel, Apt. Hot 1 �- Gal, Septic Tonk
Dwelling Sq, Ft of Loach Line
o `xI�T o? Otit1►.(3Boz. � x � Saapap Pit
—.�._ Commercial Building /s'�G J
Swimming Pool Cannoetlen to 5®wt1►
; :: �b �i+3d4� : ti i kr� �iiAPe► §Abriiii j-&viebt May be dlithif0d IhI6 thb ilidIVIdulil WM6 ill 00401
tytf�ttt h0vwith iaPPr6-d w4hcut clearance from the Water Quality Control Board
Wator. supply St �\a,,a%,3i; J ;, 1ation must be from an approv+d s2urce, EXIS T. �C V CIJD
_. .� All s+2v"e disae (;ns must conform with requirements of current Uniform PlumbIrq' **&'
'2L— Any'Cutt wo. o®1 gr�;k4, or filling in excess of four (4) feet will nullify t'+m*P dispu§al �� rr , 1
i A ha been vbta[ncd from the Regionalttrs! Water QualitV Ca,qrd for Itt�f op roof Ow !;f)t0:
ettm tttthe Rimrswe County=Erv
Health +des forw% �t 9% tI/* il�ctareW dt a&cry
on. R/L - - _
114 V f r Vi A IN TA I N 10,0-% E" e1t��� 1 k-1 '� 1;P,'. nr• `;Y.tt;' LL- 7�
r,,,,:.:,. , A. !'vl,,•I. rig 1 A: L
MIN. 10` I 0'Ji A11Y ,TliEE Uz WVER MAIN ��� L ct
NOTE: NU HAZARDOUS (riNTERIAL CAN BE STORED OR I ERATED AT THIS SITE
u,Zia�.
THIS APPROVAL GRANTED BY THE
DEPARTMENT OF PUBLIC HEALTH vsa aa- these piano oy tine uepument to nett.
6S VALID FOR GIVE (1) YEAR �th of,'Everelde County does not relieve the 1�jp
FROM DATE OF APPROVAL. W or AreMteet of the responsiblility for the
Enghwo
rant eor Anhitectarsl diasiapa."
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