05645 (RPL)Building
Address 53»$55 V WCO
Owner.,
Mailing '
' . Address WE
City , Zip
LA, QULITA 92253
Contractor ,
VN11QUE LS ' $Y CAHM2E
Address
74-818 VELIE WAY #1
City _;;�Zip
P AET 92260
State Lic.
& Classif. 52443:2 C--53
Arch., Engr., '
Designer
Address
P.O. BOX 1504 No. 05645
78-105 CALLE ESTADO .
LA QUINTA, CALIFORNIA 92253 .
BUILDING: TYPE CONST. - OCC: GRP. - -
A.P. Number' 774A-164--018
Tel.
64-77041 Legal Description
^• Project Description' PM FOOL
Tel.:
346-6335
City
Lic. # -' 1366.. .
Tel.
Sq. Ft. No. No. Dw..,
Size- • • - - w s - Stories Units
New ❑ Add ❑ . Alter ❑ Repair ❑ Demolition ❑ ,
City
Zip
State
'
Lic. If
LICENSED CONTRACTOR'S DECLARATION
I hereby'affirm That 1 am licensed under provisions of -Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code,
effect.,° e , and my license is in full force and
�� r� �:. j l f
�".�•�".`i
-
SIGNATURE ' - -.%7'"• - - ' DATE
OWNER -BUILDER DECLARATION
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
:`;
Estimated Valuation
permit to construct, alter, bnprove, 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 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 two hundred dollars ($500).
O 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 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.)
PERMIT '
-
Plan Chk.• Dep.
Plan Chk. Bal.
COrISt . '
Mech.
Electrical
❑ I, 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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. - R. 8 P.C. for this reason
S.M.1.
Grading
Driveway Enc.
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate oeconsent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certifiedcopy4thereof. (Sec. 3800, Labor Code.)
Policy No. company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed'ff the permit is for one hundred dollars (5100) valuation'
or less.)
I certify that in the performance of tho 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: d, 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.'
CONSTRUCTION LENDING.AGENCY '
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.)
Lender's Name
Lender's Address
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 is correct.
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.
Signature of applicant Date
Mailing Address I
City,. State, Zip
Infrastructure
7,500
TOTAL
REMARKS =:s r t'r > :.( _;;• a• `te a' a3 "t_t5i". '>'1 # ri '
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. t
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date %17/39 Permit f
Validated by:
Validation:
AMOUNT
64.35
: Z7,.t11`�
:`;
TOTAL
REMARKS =:s r t'r > :.( _;;• a• `te a' a3 "t_t5i". '>'1 # ri '
� ,�•qj..�,s. �+�.�a^R'Y° w°"'8'4>Z•:, elf«. ;.... H: •R^Y'i:;Y 3. "' •
. t
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date %17/39 Permit f
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL SO. FT.
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
SEWER OR SEPTIC TANK
ROUGH WIRING
POWER OUTLET
DRAINS
GAR. SO. FT. ®
IROOF
METER LOOP
DRAINAGE PIPING
CAR P. SO. FT. ®
REINF. STEEL
WALL SO. FT.
TEMP. POLE
DRINKING FOUNTAIN.
URINAL
SO. FT. ®
WATER HEATER
SERVICE
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTONDISH)
APPLIANCE DRYER
FRAMING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
GAR FIREWALL
SO.FT.GAR ® 3Ac
HOUSE SEWER
LATHING
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 GOND. 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
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
I&NAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL