08683 (RPL)T
r C(/,,
P.O. BOX 1504 ,' No. 086,83—
Building
Ei6,83Building 78-105 CALLE ESTADO• -
Address 440060 Tiara LA QUINTA, CALIFORNIA 92253 � t
Owner
Mailin 9 BUILDING: TYPE CONST. OCC: GRP.
Address axqtz A.P. Number f
CityJ— Zip ITel.
Legal Description
Contractor. Project Description' :>001, AND SPA
Address
0-975 Indio Blvd. -.
City Zip Tel.:
1 T'f Ate..
State Lic: Cit , , - � Y
& Classif.,,.690 Lic. # Sq. Ft. ,No.f' No. Dw. '
Size Stories Units
Designer '•' New ❑ Add ❑ Alter ❑ Repair ❑ Demolitiori ❑
Address Tel.
City Zip State;
' Lic. # 5
., LICENSED CONTRACTOR'S DECLARATION
I hereby affirm thaam licensed: nderprov Bions of C aFi p4e? 9 (commencing with Sectiop/. 1
7000) ofLDiviision (5Whe-BBttfiii-�.s.'ss•and"Professions Cod-anng my license Is, f �11+fo)rce
effect.
SIGNATURE) "9v-'• ATE '{
OWNER•BUILDER DECLARATION
.R• Estimated Valuation
I here" by,e firm 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 for such permit to file 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) or -
Division 3 of the Business. and Professions Code, or that. he is exempt therefrom, and the basis s, -
for thealleged 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 ($500): -
A,.as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. '-70.20
o -the work, and the structure Is not intended or.offered for sale. (Sec. 7044, Buisness and Const. MAO
;% 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. '24.00
�., provided that such improvements 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 Electrical 45• )
of proving that he did not build or improve for the purpose of sale.)
;• O I, as owner -of the property,.am exclusively contracting with licensed contractors to con- Plumbing
27.0�
' 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. - • 63
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) s
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner 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, ora certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. O Certified copy is hereby furnished. '�' _ t` f
TOTAL '274.21
CERTIFICATE OF EXEMPTION FROM` '- ' ':,j
WORKERS' COMPENSATION INSURANCE REMARKS r. �� 64_ 'Y41S4 4 Et. e? a : 41,E
(This section need not be completed if the permit is for one hundred dollars t($100) valuation - - 4 M -0..f}911 Ito )_i.�.1, D
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. j p
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you 'should become ZON E: ' ' BY: '
subject to the Workers' Compensation provisions of the Labor Code, you. must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line '
`
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY i
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 if 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 r
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.
Validated by:
Signature of applicant -Date._
t
Mailing Address
Validation:
City, State, Zip
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES.
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
ROUGH PLUMB. BONDING (B(&/% 1 p
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEQUIP.
DRAINAGE PIPING
CAR P. SQ. FT.
GAS (FINAL) �O—// v TEMP. POLE
WALL SQ. FT.
GROUT
DRINKING FOUNTAIN.
SQ FT ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FRAMING
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
REMARKS:
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
MESH
SQ.FT.GAR ® 3/ac
HOUSE SEWER
INSULATION/SOUND
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 !�V ��/ a NDERGROUND ��_� _ G.7
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING (B(&/% 1 p
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) �O—// v TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ —Plus—X$—=$
LUMBER GR.
FINAL INSP. Gi (�,
FRAMING
FINAL INSP. Aq �a(Q (L
ROOFING
W GD,
4. ",, fi,,V Jr MOW
JNT�/�Cs�l�
I
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION ( L
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL