08602 (RPL); P.O.'BOX-1504 08602
Building,'78-105 CALLE ESTADO ,
Addres44-095 'Pi8�8 LA QUINTA, CALIFORNIA 92253 1
Owner
BUILDING: TYPE,CONST.•. SDA . OCC: GRP.
Mailing
Address A.P. Number-
• City Zip fel.
Legal Description
Contractor. Project. Description
g is � F,afs�
.Address
80-975 Indio Blvd.
City. Zip Tel.'
'
012en,
State Lica City
& Classif. Lic. # Sq. Ft. No. No: Dw.^
Size.Stories '.Units
Arch., Engr:,
;Designer New ❑. Add ❑ Alter ❑ Repair •.-,;_:Demolition ❑
Address Tel. -
e
City f. Zip State
a Lic. #
LICENSED CONTRACV0R:'S DECLARATION
I lieieby affirm that I am jceasvol undeuProvisions of Chap�er_9_(commencing witfi Se tion
7000) of Division•3•0f1h Businesssaan"'d,Profe`ssions Code, and-mylicense is -In -full for�and"
effect. .�l�B,d''.•^P��..^ �' F
SIGNATOR - i•"" f` - /" DAT '
OWNER•BUICOER DECLARATION_
*
ss
1 hereby affirm that I am Estimated Valuation
exempt from the Contr'actor's License Law for the following �i� -
reason: (Sec. 703 1.5, Business. and Professions Code: Any city or county which requires a •p�
permit to construct, .alter, improve, demolish, or repair.any structure, prior to its issuance also
requires the applicant for.such permit.to rile a signed statement that he is licensed pursuant to - PERMIT :i AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section ,7000) of
'Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and'the basis
-
for,the alleged exemption. Any violation o/ Section 7031.5 by 'any applicant for a permit Plan Chk. Dep. '
subjects the applicant to a civil penalty of not more than live hundred dollars ($500).
' :;p; 1, as owner of the, property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 9.3.kg
": do;the work, and the structure is not intended or, offered for sale. (Sec. 7044, Buisness and'
hro;Professions Code: The Contractor's LicenseLaiv does not •apply, to an owner o/ property who Const.
rri :,:builds_or -improves thereon and who does such. work': hlmselloi-through his own employees, Mech. ,
:� e. provided. that suchylmprovements are. not'intended or. o/lered Ior sale. 1/, however, the building
,:�.-orlmpiovement is sold within one year of completion, the owner•builder will have the burden Electrical -
.��''u of proving that he did not build or improve !or the purpose of sale.) -
O I, as owner of the properly, 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 contractor(s) licensed pursuant to the Contractor's License Law.) - -
❑ 1 am exempt under Sec. B: & P.C. for this reason Grading �•
Driveway Enc.
?Date owner Infrastructure a
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.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. `` `
TOTAL 4t
CERTIFICATE OF EXEMPTION FROM REMARKS f1t1't<'+. ,7i �)`�'W ' SRf.�
WORKERS' COMPENSATION INSURANCE
(This section need not be completedif 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 Owner ` -
NOTICE TO APPLICANT: I!, after making this Certificate of Exemption you should -become' ZONE: BY:
subject to the Workers' Compensation .provisions of- the Labor ,Code, you must to 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 AGENCYSide.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
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'
Mailing Address Validation:
City, State, Zip
1 .'6+ • s t...A F •ry r V+',,,, ;�.'+C3�.!�•1K,
.., i 'j.'t,`. �. _ a a �fM� i '. 4 r .. .i ��. 1... - . • �' }. i .>. 1. r>`� f } ; }^ v^ ; - ..• Y.�� -
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
DUCT WORK
DRAINAGE PIPING
WALL SO. FT.
DRINKING FOUNTAIN.
SO FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
I
I WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ -Plus-X$-=$
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FRAMING
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/* c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
GAR. FIREWALL
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE EPL.CK.FEE
CONST. FEE JELECT.FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR -
SETBACK
GROUND PLUMBING (J� �Q UNDERGROUND �Q
SIQ�j
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) l �C f" �d 4 METER LOOP
J
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP l� Off` L
R L
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
FRAMING
ROOFING
�)y�//G c)
V
�,gh� Enlc.1.�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION / L
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL