002204 (MISC)P.O. BOX 1504 No. •.002204
Building 78-105 CALLE ESTADO
Address 18-650 Avenida TUJM9a LA QUINTA, CALIFORNIA 92253
Owner
CatiS L.
Mailing BUILDING: TYPE CONST. ' OCG: GRP.
AddressSam A.P. Number
City Zip Tel.
( .. YA 92253 564-4€68 Legal Description -
Contractor Project Description
Address-.-,.
State Lic.
& Classif..
Arch.; Engr.•,-'
'Designer
Tel.:
City
Lic. #
Sq. Ft. No. No. Dw.
Size Stories Units
New 0C Add ❑ Alter ❑., Repair ❑ '. - - -Demolition ❑.
Address
Tel.
CityZip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION ,.y __, • : ....- '
-
- 1 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. ..
_
SIGNATDRE .DATE•
OWNER -BUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Law for -the following
Estimated Valuation
..j .'
reason: -(Sec. J031. S,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 Pf.-
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) of
Division 3 -of the Business ahal'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.
- - - -
. Plan Chk. Dep. - -
subjects the applicant to a civil penalty of not more than five hundred'dollars ($500).
O I, as_owner of the property, or my employees with wages as their Sole compensation, will
Plan Chk. Bal.
Const.'
do the work, and thi-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* of improves thereon andwho does such work himself. or through his own employees, -
provided that such jmprovements- 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
.. ol.proving that he did not, build or improve for the purpose of sale.)
Plumbing T6.00
b. 1, as owner of the property, am exclusively contracting with licensed contractors to con-:
- Strutt 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.) • •• . .
' .._ ❑ I am exempt under Sec. - - 8. 8 P.C. for this reason.
Grading
-
Driveway Enc.
_ Date Owner A � � - A -• > _A/V. P I
Infrastructure
WORKERS' COMPENSATION DECLARATION .
1 hereby affirm that I have'a"ceFlificate'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 16.00
CERTIFICATE OF EXEMPTION FROM
WORKERS'. COMPENSATION INSURANCE :3
REMARKS
(This section need not be completed if -the permit is for- one hundred dollars' ($100) 'valuation
or. less.) .. .. - ... ... .. .
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 a 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 - '.
1 -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 from Property Line'
Lender's Name
FINAL.DATE INSPECTOR'
.dfiY
Issued by:, Date Permit
Validated by:
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.
Lcertify that I have read.this application and state that, the above information is correct. -
Iagree 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. t' '
Signature of applicant N` r • r `. .: > D te' -1 A /»
Mailing Address ...� r F `' "� V ",
Validation:
A4'8%1 3 20. 1600 Sl
City, State, Zip r
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES '
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. 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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. ®c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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 SEPTI TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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
�'6,FINAL INSPECTION 3
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL