002918 (PLBG)Building
77.676
Address
_
OWNER;BUILDERaDECLARATION " '"
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 construct, alter, improve, demolish, or repair any structure, prior to its issuance also
.requires the applicant dor such permit to file a signed *statement that he -is licensedpursuant 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 thathe 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 (S500): '•
❑ I, as owner of the property; or my employees with wages as their sole compensation, will
do tfie 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' suchimprovements.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.) ... -
O I, as owner bf.the property, am exclusively contracting with licensed contractors to con-
slruct 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 License Law.)
O.I am exempt under Sec. B. R P.C. for this reason
Owner
PERMIT
-
- '
Plan: Chk. Dep. • • .
Plan Chk. Bal. .
Mailing
Address
® �}'° '�
�. . �.
City
Plumbing
Zip
. : �4.
Quinta.
92253 .
Contractor.
. work for which this permit is issued. (Sec. 3097, Civil -Code.).. -
WORKERS' COMPENSATION DECLARATION
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. jSec. 3800, Labor Code.)
Policy No. ' Company
❑ Copy is filed with the city. O Certified copy is herebyfuinished.
_
CERTIFICATE OF EXEMPTION FROM
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 thg 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 - - Owrier `
Side Setback from Property,Line
....Address
saw
City
REMARKS
Zip ...
State Lic.
& Classif. 413636
Arch., Engr.,
Designer
Address
Tel..-
Lic #
Tel.
44Q
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. 'OCC: GRP.-
A.P. Number
Legal Description
Project Description
Sq. Ft. No. No. Dw.
Size - Stories Units
New j (C Add ❑ Alter ❑• Repair ❑
City Zip State 100 aimprid-ample .amd
LIC. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chaptei'9'(commencing with Section
7000) of Division 3-ol"ttie'Business arid'P.rofessions Code, and my license is in full force and
effect
Demolition ❑..
P: A T
NOTICE TO APPLICANT: If, after making this Certificate or Exemption you should become
ZONE:
SIGNATURE +' K - far' DATE
_
OWNER;BUILDERaDECLARATION " '"
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 construct, alter, improve, demolish, or repair any structure, prior to its issuance also
.requires the applicant dor such permit to file a signed *statement that he -is licensedpursuant 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 thathe 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 (S500): '•
❑ I, as owner of the property; or my employees with wages as their sole compensation, will
do tfie 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' suchimprovements.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.) ... -
O I, as owner bf.the property, am exclusively contracting with licensed contractors to con-
slruct 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 License Law.)
O.I am exempt under Sec. B. R P.C. for this reason
Estimated Valuation
PERMIT
-
- '
Plan: Chk. Dep. • • .
Plan Chk. Bal. .
COf1St.
'
-
Mech.
Electrical -
Plumbing
.. S•M.L .
Grading
Driveway Enc.
Date owner
Infrastructure
. work for which this permit is issued. (Sec. 3097, Civil -Code.).. -
WORKERS' COMPENSATION DECLARATION
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. jSec. 3800, Labor Code.)
Policy No. ' Company
❑ Copy is filed with the city. O Certified copy is herebyfuinished.
_
CERTIFICATE OF EXEMPTION FROM
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 thg 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 - - Owrier `
Side Setback from Property,Line
Lender's Name
TOTAL
REMARKS
-
" INSPECTOR'
This is a building permit when'properly filled out, signed and validated;'and is. subject to
Demolition ❑..
P: A T
NOTICE TO APPLICANT: If, after making this Certificate or Exemption you should become
ZONE:
BY: '
subject' to the' Workers' Compensation- provisions `of the Labor Code, you'must foithwith
I comply with such provisions or this permit shall be deemed revoked.
.
Minimum Settiack.Distances: '
Front Setback -from Center.Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCYSide
Street -Setback from Center Line
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.
,x,11,,,,177
I certify that I have read this. application and state that the above, information is correct.
'comply
Issued by:
Date Ti Permit . -.
agree to with all city and county ordinances and state laws relating to building '
construction, and hereby authorize representatives j,of this city to enter the- above-
mentioned for inspection.purpo +
r�f1t A.
property es" ;�
fo �. I
Validated. by:
Signature of applicant ?� ' �Date
Mailing Address ' " r
Validation:
City, State, Zip
A7305
2 11 225L CK
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. 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
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
P- 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.
SQ. FT. RESID ® 1Va c
SEWAGE DISPOSAL
SQ.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.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL)
P- POLE ,
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.4.-INAL
INSP.
FRAMING
NSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL.
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL