003421 (BLCK)44
P.O. BOX 1504
Building78-105 CALLE ESTADO
Address 5&"754 Avenida Velasco �LA QUINTA, CALIFORNIA 92253
Owner
NO. - 003421
,MRRT w.:d6?ii .,..,....,..•.... ,. -.
Mailing
BUILDING: TYPE -CONST. OCC,. GRP:
Address 11717>�9A rThr Asm C•k' _ Act Iif-P 1 n n
A.P. Number
774-165-301
City Zip Tel.
San '.D3eCfU' �� } .619-693^8444
Legal. Description
Project Description
Sol at
��fl�'ti�].1I� ncj Wal
40r1 a Q_,- 1$0 Std. St. ..
Contractor }� q a ry _ y g
el on
Address.... .. .. _
Lender's Address
Same
City
Zip
Tel. a
expiration if work thereunder is suspended for 180 days.
State Lic.
City
•1 certify that I have read this application and state that the above information is'correct. '
Issued by:
& Classif. 330551
Lic. # 859
Sq. Ft.
No. No. Dw.
construction, and hereby authorize representatives -of this city to enter the above-.
Size
Stories Units
Arch:, Engr.;
Designer
New ❑ Add ❑ Alter ❑ . - Repair ❑ Demolition ❑
Address
Tel.
Mailing Address
Validation:
City
_ -1
Zip
State
Lic. #
.F
LICENSED CONTRACTOR'S DECLARATION .
I hereby affirm t a I arri licensed under.provisions of Chapter 9 (commencing with section
7000) dLDivisionf3 of the Business and Professions Code, and my license is in full force and
eff� f r -.%s% f
_ -
DATE
Y
r /v OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Cont actor's License Law for the following
reason: (Sec. 7031.5,Buslness and Professions Code: Any -city or county which 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 is licensed pursuant to
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 of Section 7031.5 by 'any applicant for 'a permit
subjects the applicant to a vivil penalty of not more than five hundred dollars ($500).
.. ❑ 1, as owner of.the property, of 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..
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.)
Estimated Valuation
wg
$924
- -PERMIT
- AMOUNT
Plan Chk. Dep.
-
Plan Chk. Bal.
-
Const.
Mech:
.
Electrical
,
Plumbing
O 1, as owner of the property, am exclusively contracting with licensed. contractors to con-
strucl 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 contractors) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
S•M.I.
-
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. ❑ Certified copy is hereby furnished.
TOTAL
r
_
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
' .. ,. -
•.r
(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
employ any person in any manner so as to become subject to'the Workers' Compensation
Laws of California.
.i:.-.
r i -�ff
Date' Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become.
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY: '
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 if work thereunder is suspended for 180 days.
•1 certify that I have read this application and state that the above information is'correct. '
Issued by:
Date t A 11 f Q7 Permit
I 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 Address
Validation:
City, State, Zip
HARD COPY
T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SQ. FT. ®
GAR. SQ, FT. ®
CAR P. SO. 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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
(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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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. 12"15/GAS
(ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP: POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAMig
v ZGRADING
WATER SYSTEM
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 SIGNATURESIIMITIALS
GARDEN WALL FINAL