002051 (PAT)4'14
P.O. BOX 1504 N o . � � �
Building 78-105 CALLE ESTADO
Address' 79-650 „ 'IAUIMA LA QUINTA, CALIFORNIA 92253
Owner .•. .. .... .... .. . . -
!*w,«•t'ta �"it ev"wa
Mailing:BUILDING: TYPE CONST. OCC: GRP.-
. _ .- .—
Address s A.P. Number 70-0610•
City Zip Tel.
Legal Description lot 22
Contractor
Project, Description
}s.ap �yf� /meq
..• .-`��'• L: SAO C:PA�i.if4'..♦V _
Address. .-:. .. ......... .. �:
A111-421 rta P"ff .60 lin.-ALof 3 fes. high.. M.W 1.
City .. ' Zip Tel.,
State Lic. City
& Classif. Lic. # Sq. Ft. No, No. Dw.
- •Arch.; Engr; ... _. .. _ ,.
Size - Stories - Units
' 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 Division 3 of the Business and Professions -Code, and my license is in full force and
effect.. .. .-.
-
_ •. ., ,•
SIGNATURE DATE
OWN ER -BU ILDER'DEC LARATION
I hereby affirm that I am exempt from the Contractor's- License Law for the ,following•
,reason: _(Sec., 7031.5, Business and Protessions 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'
the provisionsof the Contractor's License Law, Chapter ,9 (commencing with Section .7000) of
' DiWsion- 3 of 'the Business and Professions Code, or that: he is exerript therefrom, and the basis-..
.for the alleged exemption. Any violation of Section 7031.5 by 'any .applicant .fora permit
Estimated ValUatlOQ
1.608220,00' .
- - PERMIT
.
- --
' +'-• AMOUNT
• - -
-Plan• Chk. Dep.
.
.. - ..
- 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
Plan Chk. Bal.
- - -
Const.
do the 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.,.
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
EIBCtrICdl
'
. 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.conlractors to con--
slrucl-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.)
.p 1 am exempt under Sec. B. & P.C. for. this reason
S.M.I. -
_ S� -
Grading
Driveway Enc.
Date Owner fry r` .° .
Infrastructure
WORKERS' COMPENSATIONDECLARATION
' I hereby affirm' that I have a certificate of consent -to self -insure, or a certificate of
y Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) -
-
' Policy No.- - • Company.
0 CopyJs filed with the city. , ❑ Certified copy.is hereby furnished. '
TOTAL
REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
- +- - -
(This section need not be completed if the permit is for one' hundred dollars IS 100) valuation
or less.) . .. .. - .. ...
1 certify that in. the performance of thg work for which this' permit is issued, I shall not
employ any person in any manner so asrto 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, Code, you.m6st '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 -for the'performance of the.'
work for which this permit is issued. (Sec. 3097, Civil Code.) - _ -.
Side' Street Setback from Center Line '
Side Setback,f from Property Line
Lender's Name
FINAL DATE
Issued -by:
Validated by:
Validation:
A 4 2 6 8
INSPECTOR
'Date 2-19— Permit
2 18 1(,3,62 it
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 andstate laws relating' to buildirig
construction, and hereby authorize representatives of this city to -enter the above-.
mentioned property for inspection purposes.
_
Signature of applicant ��/f r d .. i!• 4 -'Date
Mailing Address t, ,r•/ 'c trwKs
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
.2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CARP. 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.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
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
ROCKSTORAGE
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.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
ENCE FINAL.
vv
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL