03926 (BLCK)•
1 0 P.O. BOX 1504
78-105 CALLE ESTADO '
Address � �� '� LA QUINTA, CALIFORNIA,92253 5.
Owner s
Joe Stemar,
Mailing BUILDING: TYPE CONST. OCC. GRP.
` � - •-
Address 79-940 `11orsashoe ^ A.P:•Number.•- " 774-4,65 .000 .
City. Zip Tel..,
La
. QU,ifta 02253 '3 71" +t 4 Legal Description
Contractor- r40 �at rJ' � high tonneOwr�er.
tSuilder
Project Descriptioh
Address
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
7000) of Division.3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION -
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated ValUatlOn'$10000
aA / 000tltl2i
- 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
• requires the applicant for such permit to4ils a signed statement that he is licensed pursuant to
PERMIT
"AMOUNT +'
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
s
Plan Chk. Dep.
- r
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 five hundred dollars ($500).
O 1, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Bal.
_
Const.
ti�'�_�
IL
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
Mech.
builds or improves thereon end -who does such work himself or through his own employees,
builds
provided that such improvements are not intended or offered for sale. If, however, the building
Electrical
`
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.)
Plumbing
O 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
' 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
-�
O 1 am exempt under Sec. B. & P.C. L r,.tAis reason
Driveway Enc.
Date Owner `r'°' `"
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
O Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL
s
• CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
_ -h i .S' •�a _ 4% a"�(yl•'j'•� ' g,i�,,; a ,(y.;,,{xa'� '. !•:' '{ �• �
(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 thg work for which this permit is issued, I shall not
w.ila ,cif � ���f3�r... �,. _ --
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
NOTICE TO APPLICOANTr 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 ith such provisions or this permit shall be deemed revoked. -
Minimum Setback Distances:
Front Setback from Center Line
F + CONSTRUCTION LENDING AGENCY rr
Rear Setback from Rear Prop. Line
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
This is a building permit when properly filled out, signed and validated, and Is subject to
'expiration It work thereunder is suspended for 180 days.
FINAL DATE
INSPECTOR
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.
Issued by: "
Validated by:
Date Permit •
Signature of applicant ' Date
•. 'Mailing Address '
'. Validation: - -
GOLDENROD -ASSESSOR'S OFFICE, HARD COPY
!--.fi.'::'ti r+:; Ste+"�.+: ,... .�.,. 't•t'.d�,. - _....
.T�. h,. •- ,"?li:^ •.S.Jf' is .n 1..� .;{. ham'.
p City;' Slate, • Zip,
INANCE PINK APPLICANT GREEN BUILDING;
� i --WHITE FINANCE,
�fi:fh ;'�. •.Yc, �,. Y4c.^. ., ... '�'...l:E;4{J.ew±z.I-. ...'�.rtl .._cn.; "Si.i:r•r.Y._fn.. ,.. _ ,��..1. ...� -.'".Y'r-rs...a_x.G7.`...>.�+'1!""u
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
IST FL SO FT y $
UNITS
UNDERGROUND
A.C. UNIT
COLL. AREA
SPKLR SYSTEM
2ND FL SO FT. aYARD
BONDING
HEATING (ROUGH)
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR SO FT. ar
DUCT WORK
ROCK STORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR SO. FT. fpE
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO FT. 9
GROUT
WATER HEATER
WALL SO. FT. (a
FINAL INSP.
DRINKING FOUNTAIN
&OND BEAM �
WATER SYSTEM
URINAL
SO. FT. a
_$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION S
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(AUTONDISHI
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIREPLACE
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
MESH
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1 V. c
SEWAGE DISPOSAL
FINISH GRADING
SO.FT.GAR re >r.c
HOUSE SEWER
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 8 AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS 5 O�
EWER OR SEPTIC TANK
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.
&OND 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. FIREWAL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUPESIINITIALS
..
GARDEN WALL FINAL :d