08566 (PLBG):3- ..... -A.' Q
44
P.O. BOX 1504 N o . 08566
Building 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner..
W'Rdt?.mA BUILDING: TYPE CONST. OCC: GRP.
Mailing ' ' " ° r
Address i A.P. Number
CityZip Tel.
-nm*Q r 4 --Qr" 4 Legal Description
Contractor Project Description' saw1w Pftr nit
Address
City Zip Tel.:
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr., -
Size Stories Units
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 Estimated 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 the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT construct, alter, improve, demolish, or repair any structure, prior to Its issuance also AMOUNT
requires
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
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 Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars (8500). .
0 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
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, Mech•
provided that such improvements are not intended or offered for sale.. If, however, the building
or improvement is sold within one year or completion, the owner -builder will have the burden Electrical
or proving that he did not build or improve for the purpose of sale.)
14,�Inas 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 contractors) licensed pursuant to the Contractor's License Law.) -
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc. -
Date "� ( Owner "1 = r.- A 1"- • t:; Infrastructure
23.E
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.) f'
Policy No. Company
❑ Copy is filed with the city. ❑.Certified copy is hereby furnished.
TOTAL 30.00
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed A the permit is for one hundred dollars ($100) valuation a 4 i4 .'y *�} ,r{ ¢,�' I �- -R "A0
'or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in an manner so as to become subct t ih
Y
Laws of California. fe o e o ers, ompensa on
fir" /.
Dare t i k`
• Ile-,
Owner?P,
y
NOTICE TO; APPLICANT: If, aftermaking 'this Certificate _ of Exemption you' should become
ZONE:
BY:.
subject to the Workers' Compensation provisions of the. Labor Code, you;must forthwith
comply with 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
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 it 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_Permit
I agree to comply with all city and county ordinances and stale 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
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO, FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SO FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
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 & 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
� � / '%/Aye
a
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