003341 (BLCK)r , 4r QumiL
' .
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address .:48-114 SER& 3 LA QUINTA, CALIFORNIA 92253
Owner
PAUL TMA
(wailing
Address SAME
City
.. ...L,A.. Q=TA
Contractor
kali
Zip (Tel
92253
Address.
48-916 EISMTWM. DRM
'City ..... .. .Zip ... Tela
LMLO 92201 346-2053•
BUILDING: TYPE CONST. OCC:'GRP.'
A.P. Number 617-.i43g?-006
Legal Description
Project Description P.WLr A16 �A Akll 871 0I+'
6* HIGH BLACK WAU
State Lic.
& Classif..Z�U� �53sC26yO `, ..
City
Lic. # 0
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 Division13 of the Business and Professions Code, and my license is•in.full force and'
effect. .. r r. .
�•i' .�aKt.!°f1 >1�__f.fili.3 ..r�.iwi.,,,..,._. r. ,". ,y e� i
r
.. ..
.. ..
SIGNATURE' •Y DATE
OWNER•BUILDERDECLARATION
I hereby affirm that 1 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
.reason:
to construct, alter, 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 3of 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).-
❑ 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. 1044, Buisness and--'
Professions Code: The Contractor's License Law does not apply to an owner of.,property who
Estimated Valuation
t
.. PERMIT
'
- AMOUNT" -
' -
PI2n.,Chk:, Dep: -
- - -
Plan Chk. Bal:.
®�
Const. '
- - �f - sn
-
Mech.'
-
�Ifa_i�n
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
❑ 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
' such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B.,& P.C. for this reason -
S.M.I.'
•" - ,*�"
Grading
-
Driveway Enc.
Date owner
Infrastructure
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. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city.. O Certified copy,is,hereby, furnished. .
TOTAL
X35 (►9
_
REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
-
(This section need not be completed if the permit is for one hundred dollars (5100) valuation
... or less.) _ ... ..
certify that in the performance of the 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.
. .
n c a:xr_<. :. � tYc�r✓_, t <h x��_-.sX^r, � ,; }
TV, 1:11 A1,– b 1 ty,^... , .- . 4
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
complywithsuchprovisionsorthispermitshallbedeemedrevoked.
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 for the. performance of they
'- work for which this permit is issued. (Sec. 3097, Civil Code.) • .
Side Street Setback from Center Line '
Side Setback from Property Line
Lender's Name
FINAL DATE
INSPECTOR
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 ordinarices 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 a;.�9 0—'Permit
a — r dY
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. p $
UNITS
COLL. AREA
2ND FL. SQ. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
ROCK STORAGE
DRAINAGE PIPING
WALL SQ. FT. ®
DRINKING FOUNTAIN
SO. FT. ®
OTHER APPJEQUIP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
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(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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
SQ.FT.GAR ® 3/acHOUSE
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 APPJEQUIP.
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
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESINITIALS
GARDEN WALL FINAL
P
r
EIS
�n, true, Street
t 7 t G} 476-W. 8
SP
1- 175;o o o AAYs