04831 (BLCK)e
.04
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04834,
+' P.O.
BOX 1504
Building 78-105 CALLE ESTADO
Address 53-230 `�elasao LA QUINTA, CALIFORNIA 92253
Owner
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BUILDING: TYPE CONST. OCC. GRP.
rMailing
Address Same ��
A.P. Number ,_ �7�-055--010
City .
Zip
Tel.
, �
9225 �
5,64,fr1909
Legal Description
ContractorProject
Description WOOL •A-Ct '00 50 X, V hiah
Owner/rudder
Address
City
Zip
Tel.
• State Lic. ..
City
& Classif.
Lic. If
Sq. Ft. No. No. Dw.
Size Stories Units
Arch., Engr., Z
Designer tt
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 Divisionof the Business and Professions Code, and my license is in full force and
.3
effect.
SIGNATURE DATE
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
reason: (Sec. 7031.5,Business Code: Any city or county which
*� - t'
and"Professions requires a
" permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit•to rile a signed statement that he islicensedpursuant 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 Section7031.5 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, Suisness and
Const. « �
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
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 ckontractors 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 contractors) licensed pursuant to the Contractor's License Law.)
Grading
0 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
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❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
` CERTIFICATE OF EXEMPTION FROM
REMARKS f9,4- ;! f7 jr� � —
WORKERS' COMPENSATION INSURANCE
' (This section need not be completed if the permit Is for one hundred dollars ($100) vatuafion
lilt
,„',•j ”' t-7
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.
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 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.) . -_ Y
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 1s correct.
tfg,
Issued.by: Date W/ i Permit
I agree to comply with all city and county ordinances and slate 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
WHITE FINANCE PINK -APPLICANT, GREEN BUILDING,
GOLDENROD ASSESSORS OFFICE HARD COPY- FILE
i" Y:.
_. ?S.. -__ -f.. y..,�#.i. ...hS-.�-...-J �. L. _^:._r...r... _ •. v r. - X,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
A.C. UNIT
COLL. AREA
SLAB GRADE
1ST FL SO FT (p $
UNITS
HEATING (ROUGH)
STORAGE TANK
FORMS
YARD SPKLR SYSTEM
2ND FL SO FT. a
DUCT WORK
ROCK STORAGE
FOUND. REINF.
MOBILEHOME SVC.
BAR SINK
POR SO FT. at
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. Or
GROUT
WATER HEATER
SERVICE
FINAL INSP.
DRAINAGE PIPING
CAR P. SO FT. a
WATER SYSTEM
WALL SO. FT. (d
=$
DRINKING FOUNTAIN
FINAL INSP.
URINAL
- SO. FT. (a
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ENAUT09DISH)
APPLIANCE DRYER
FIREPLACE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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 ( t'A c
SEWAGE DISPOSAL
SO.FT.GAR ar 3/.c
HOUSE SEWER
CERT. OCC.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
Iv.ECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 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 APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus xE
=$
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 SIGNATURESIINiT1ALS
GARDEN WALL FINAL