07301 (BLCK)TAh
4
t P.O. BOX 1504 No. 07301.
:.'"'Building r53b820 Mum78-105 CALLE ESTADO
Address . LA QUINTA, CALIFORNIA 92253
Owner :..,. , .. . - .. ; .. ... ..
LO
BUILDING: -TYPE CONST: OCC: GRP w
Mailing I
Address 78-401 RWY 111 _ A.P. Number 774-165-005
City Zip Tel.
a Quin ..fin 564.1205 Legal Description
ContractorProject Description 21 X 1001 Retai in'01 Wall
: .Aaaress -
PO Box '2982 ..
City- Zip Tel.:
Palm Desert 92260, 340-6807
State Lic. r City
& Classif.. '• Lic. # 126
` Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed�under.Drovisions of Chapter 9 (commencing with Section
7000) of Division '3 of the Business and"Professions Code,iand mylic rise is in full force and
effect. �� s� �.4" /� a t� �% j J. r.�r'
'SIGNATURE `....+` DATE
i
OWNER -BUILDER DECLARATION'
;.t I hereby affirm that I am exempt from the Contractors License Law for the following
reason: • (Sec. 7031.5,Business and ,Protessions Code: Any city or county which requires a
permit to construct, atter, improve, demolish, or repair any structure, . pdor to its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Divisfon 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 civil penalty of not more than rive hundred dollars ($500). -
❑ 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, Buisness and
Professions Code: The Contractor's License Law does not appy 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 safe. d, however, the building
or improvement is sold within one year of completion, the owner -builder win have the burden
,1- 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 contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
t ' does not apply to an owner of property who bunds or improves thereon, and who contracts for
. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
A ❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that'I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
' Policy No. Company
1 ❑ Copy.is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
it
WORKERS' COMPENSATION. INSURANCE
(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.
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 such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:
'
Front Setback from Center Line
'
Sq. Ft.
Size
No.
Stories
No. Dw.,
-- Units '
New ❑ • Add ❑
Alter ❑.
Repair:❑ • 41.' .'Demolition.❑
.—Side
Side Setback from Property Line
l
I Lenders, Name
,
iLenders Address
FINAL'DATE
INPEQ9T0OR
{ This i5 a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 1130 days. .
1 certify that I have read this application and state that the above information is correct.
Issued by: '
Date Permit'.
Estimated Valuation
$39,75£
PERMIT
AMOUNT
Plan Chk. Dep.
" Validated by:,
Plan Chk. Bal.
".
Const..
. 00
Mech.
Validation: -
,
Electrical
u
Plumbing
S.M.I.
.28r+
Grading
Driveway Enc.
Infrastructure
f'
'
TOTAL
REMARKS
" a�ds14?d.sFtslc'I.�,i)T.,x -icy c i
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 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
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
Side Setback from Property Line
l
I Lenders, Name
,
iLenders Address
FINAL'DATE
INPEQ9T0OR
{ This i5 a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 1130 days. .
1 certify that I have read this application and state that the above information is correct.
Issued by: '
Date Permit'.
i 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:,
t: .Signature of applicant Date'
!
li .Mailing Address
Validation: -
,
City,. State, Zip
u
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SO. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. Sp. FT. ®
DUCT WORK
ROCK STORAGE
FOUND. REINF.
I 1POWER OUTLET
DRAINS
GAR. SO. FT. ®
HEATING (FINAL)
IROOF
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
WALL Sp. FT.
WATER HEATER
DRINKING FOUNTAIN.
FINAL INSP,
URINAL
Sp FT ®
WATER SYSTEM
ESTIMATED CONSTRUCTION VALUATION $
GRADING
cu. yd.
$ plus x$
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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.
Sp. FT. ® c
BATH TUB
LATHING
SO. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Vic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
M=CH.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.
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
/f
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL 71