003181 (RC)Bdsg
Adddreress �
78-120 1e Ta ito
Owner
Bob Mnmrd
Mailing
Address P_ 0 1if;5
City Zip Tel.
QUM&
P.O. BOX 1504
•78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING:- TYPE CONST. - OCC: GRP.
A.P. Number.
Legal Description
Project Description RA4Frsneellwelr• sr~Ffl•,®1r .f4a+A
HARD COPY I.
City .. Zip • _ ..
14 QuinIm 32233
Tela ..
64-9250.
State Lic.
City
& Classif.
Lic. #
Sq. Ft. 3203
Size
No. No. Dw.
Stories Units
•
- .; Engr.; _ ... ..
Arch
Designer
New ❑ Add ❑
.,
Alter ❑ - Repair C i Demolition ❑
Address
Tel.
City
Zip
State
Lic..#
LICENSED.CONTRACTOR'S DECLARATION
.. .
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. 1./4,,...r-...,-. P> ... .. - 1`.y z.
.... ......
.. .. ,
SIGNATURE 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
_ -
-
- '" AMOUNT
permit to construct, atter, improve, 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'Susiness.and Profession§ 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 (8500).
❑ 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 andCOf1St.
Prolesslons Code: The Contractor's License Law does not apply!to an owner ol-property..who .'
--
Plan'Chk. Dep. -
'
Plan Chk:. Bal.
ASK `9*2
- '
Mech.
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,
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-
struet 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.) - -
11I am exempt under Seca . B. 8 P.C. for this reason
S.M.L.
_
Grading
Driveway Enc.
Date Owner.
Infrastructure
WORKERS' COMPENSATION DECLARATION
hereby 'Affirm that l 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. ❑ Certified copy is hereby.furnished.
TOTAL.
'REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
'
,..,- eseft.c' �.,-, ne ,•-..
.ti.;gImf.
r .. ,t•' r .r a . �.-
(This section need not be completed if the permit is for one hundred dollars (8100) 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 " ' Owner
.NOTICE TO APPLICANT: If, 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. -
ZONE: BY: '
Minimum Setback Distances: -
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY.
I hereby affirm that there is a construction lending agency or the 'performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Side Street Setback from Center Lirle
Side Setback from Property Line
Lender's Name
FINAL DATE
Issued by:,
Validated by:
INSPECTOR
Date A/74 /A7 Permit -
_T
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
Validation.
City, State, Zip
HARD COPY I.
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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROUGH WIRING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROCK STORAGE
LAUNDRYTRAY
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.
SQ. FT. @ c
BATH TUB
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
WATER SYSTEM
SQ.FT.GAR @ 3/ac
HOUSE SEWER
GRADING
cu. yd.
$ plus x$
_$
GAS PIPING
PERMIT FEE
FINAL INSP.
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)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
r
I/i"FRAMING' "7— Y
FINAL INSP.
ROOFING '
.. _ DEL
a'
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL