001647 (RR)Building
Address 53-2W Vel
Owner
€3
Mailing
Address 53-200 hAmMa Ve:
City Zip
L Q rota 92253
Contractor
.,Address
78-550
City Zip
%* .ts 922201
44
P.O. BOX 1504 No. 001647
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
- .. BUILDING: TYPE CONST. - - OCC:.GRP.-
A.P. Number
Tel. �--
0-3421 • - Legal Description
Project. Description�;� to i�Of C> �
=M - rM-tx-_111 M- edg-SIS, I IaSw 30. 1b. felt
Tela `
U 34"-3751coated whita.
i4th,2riyacp
.15 L3•
cwrl
State Lic.
City
BY:
- to the Workers' Compensation provisions' of the Labor' Code, you must forthwith"
comply with such provisions or this permit shall be deemed revoked.
& Classif.- 274 921
Lic. #
Sq. Ft.
No. No. Dw.
•
i
Sze• -
Stories :.. -Units
Arch., Engr., .. ._.
SideStreet Setback from Center Line '
...
Designer
New O Add ❑
Alter ❑ Repair ❑.., Demolition ❑
Address
Tel.
Lender's ,Name
City
Zip
State
INSPECTOR
expiration it work thereunder is suspended for 180 days. '
Lic. # ... -
Issued by:
Date- Permit
LICENSED CONTRACTOR'S DECLARATION
-
^•
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with•Seotion
7000) of Division 3 of the Business and Professions Code; and.my.license is in full force and
effect. - - F. .� . . , .
- •.. - - • .
SIGNATURE .6 " DATES
^ OWNER•BUILDER DECLARATION
1 -hereby affirm that -I am exempt from the Contractors License Law .for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county .which requires a
. permit to construct, alter, impiove, 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 -
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.oasis --
for the alleged exemption. Any violation of Section 7031.5 by -any applicant for a permit
subjects the applicantto a civil penalty of not more than five hundred dollars'($500).. . ' • -
" ❑ 1, as owner of the property, or my employees with, wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
Estimated Valuation
-'
Signature of applicant Date
- -PERMIT
- AMOUNT
- - -
Plan Chk. Dep.
- -
Plan Chk. Bal.
-
fiO.nSt. '
-
Mech.
_
builds or improves thereon and who does such work himself or through his own employees,
provided that such .improvements are not intended or offered -for sale. If, however, • the building -
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or Improve for the purpose of sale.). • . ,
Electrical .
-
Plumbing
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
- •struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
' does not apply.to an owner of property who builds or improves thereon, 'and who'contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law:)
❑ 1 am exempt under Sec. _-B. & P.C. foe this reason.
S.M.I.
Grading
Driveway Enc.
Date Owner
_Infrastructure
WORKERS' COMPENSATION DECLARATION
Pe2mit
I hereby affirm'that I have a certificate of.consent 'to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy NoCompany s- .?. - :, •_ '
O Copy is filed wflti the city.. O Certified copy is hereby.furn'iA d
t
. .050
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed if the permit is for one hundred dollars ($ f 00) 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.
Dat.
"
a e Owner
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you. should become
'subject ' '
ZONE: -
BY:
- 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:' .
SideStreet Setback from Center Line '
hereby affirm that there is a construction lending agency- for the performance of the
. 1. •
work for which this permit is issued. (Sec. 3097, Civil Code:J
Side Setback from PrOPerty,Llne
Lender's ,Name
Lender's Address
This is'a building permit when properly filled out, signed and validated; and is subject to
FINAL DATE
-
INSPECTOR
expiration it work thereunder is suspended for 180 days. '
Icertify that I have read this application and stale,that the above information is correct.
-ordinance's
Issued by:
Date- Permit
agree to comply with all city and county 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
A 2 1 0 1
% Z9 2&50 CK
HARD COPY
-
3
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT. 0
WALL SQ. FT.
SO. 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT • WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
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 —ANK
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
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
h4FINAL INSPECTION
CERT. OCC.
FENCE FINAL .
INSPECTOR'S SIGNATURESIINITIALS•
GARDEN WALL FINAL