003117 (BLCK)1 r4,4
P.O. BOX 1504 N o . 003117
Building 78-105 CALLE ESTADO
Address 53-521 Velasco LA QUINTA, CALIFORNIA 92253
Owner "
lot f X•; r4Dt^ l BUILDING: TYPE CONST. OCC: GRP.••
Mailing
Address A;P.,Number. 774_125-01,1
City Zip Tel.
�,9 2� Legal Description
Contractor Project Description 1501 of r-ha'in link with
�3s�•x:a�,fF�ltildal�
Address-, s iiia vtvata* 'Arid covetT nialat.Q to hi'i€:
City Zip Tel..
State Lic. City
& Classif. Lic. # 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
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section s
70 OO) of Division 3 of the Business and Professions Code; and my license is in full force and
effect.
SIGNATURE DATE - -
OWNER-BUILDER'DECLARATION EStlmated Valuation
I hereby affirm that I am exempt from the Contractor's License law for the following.
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, prior to its, issuance also AMOUNT
requires,the applicant for such permit to file a signed statement that. he is licensed pursuant to PERMIT. _
. 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 exempt therefrom,- and the basis - for the alleged exemption. Any violation o/ Section 7031.5. by 'any applicant /or a permit •* Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than live hundreddollars ($500).' - - -
❑ I, as owner of the, property, or my employees with wages as•their sole compensation, will Plan C.hk. Bal.
r - do the work, and the structure is not intended or offered for sale. (Seca 7044, Buisness and COf1St. .' - Lam'
Pro/essions Code: The Contractor's License Law does not. apply, to an owner of property. who - - •
00
builds or improves thereon arid who does such work himself or through his own employees, MBCA. '
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 EIBCtrICdl -
o/ proving that he did not build or improve /or the purpose of sale.)
DI, 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•M.I. - - -
such projects with a contractor(s) licensed pursuant to the Contractor's•License Law.) -
Grading
11 .1 am exempt. under. Sec.. B. & P:C. for this reason
`r f Driveway Enc.
Date +-• -, � 7 Owner %r a rf �j ' - .:. --' Infrastructure
_ t A01
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.) r
Policy No. ' " Company "
❑ Copy is filed with the city. - ❑ Certified copy is hereby furnished..
TOTAL A 2 n _ nn
CERTIFICATE OF EXEMPTION FROM REMARKS'
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation AfX f fkrl JPA *;170 �},k., %r1 -..Q'7 _ _ iI n
or less.) . . _ .. . . _ . . . . , _.. I._ y .
I certify that in the performance. of the 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 o/ Exemption you should become ZONE: BY:
'subject to the Worker's' Compensation provisions of the Labor Code, 'you must forthwith .Mlrllflluhl SBtbaCk'DlStanCBS: '
comply with such provisions or this permit shall be deemed revoked. -
Front Setback.from.Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY 't 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.) .. 1 Side -Setback from Property Line
Lender's Name
. Lender's Address
• This is a'building permitwhen'properly filled out, signed and validated; and.is'subject to FINAL DATE INSPECTOR
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. Issued by: Date L LALA _ Permit
agree 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
ateMailing Address Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES i
1ST FL. SO. FT. ® $
UNITS
A.C. UNIT
2ND FL. SQ. FT.
SLAB GRADE
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
ROUGH WIRING
DRAINAGE PIPING
WALL SQ. FT.
DUCT WORK
DRINKING FOUNTAIN
SQ FT @
GAS (ROUGH)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax va:uation
REINF. STEEL
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
SERVICE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
WATER SYSTEM
KITCHEN 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.
SQ. FT. ® c
BATH TUB
I��I
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FIRE ZONE ROOFING
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 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
,
C
` :
��
I��I
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL�j
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS,
GARDEN WALL FINAL