003562 (BLCK)e ..
003562
P.O. BOX 1504 N0. -
Building-,. 78-105 CALLE ESTADO
Address 78-746 Avenida 1r.nJUnc1a LA QUINTA, CALIFORNIA 92253
Owner
Mailing
BUILDING: -TYPE CONST. OCC: GRP.
Address P. 0. Box 288'
A.P. Number
City
Zip
Tel.
- La- Quinta
92253
.5��"� 2
Legal Description
- _
Prr Description
VIA
_666 . All 6 Haigh 292 a
� ' -
\ .
Con tor
.. ntr... !
J 1�a a.! r 7. 0,e d
.Address...... .... .. ..._
•...City
. .. ..........
Zip..
Tel.
State Lic.
City
& Classif:
Lic. #
Sq. Ft.
No. No. Dw.
'Size
Stories Units - -
-Arch -Engr., ... ..... .... _
-
Designer
T
New ❑ Add ❑
Alter ❑. - Repair ❑ Demolition ❑ ..
Address
Tel.
-
City
Zip
State
. , ,.
Lic.'#
LICENSED CONTRACTOR'S DECLARATION,
•'t
-
I herebyaffirmthat I am licensed under provisions of Chapter 9 (commencing with Section•
Division 3
.7000) of of the Business and Professions Code, and my license is. in full force and
,.effect. -
..
.. ..
-. ..... .. ..
SIGNATURE DATE
OWNER -BUILDER DECLARATION
' I hereby affirm 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 repairanystructure, 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'3 of theBusiness and Professions Code, or that..he is exempt'therelrom, 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). "'='-
O 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.- 7044, Buisness and '-•
. Professions Code: .The Contractor's License Law does'not apply:to an,owner of-propa y'who
Estimated Valuation ,
m
7 ...
PERMIT •
--• AMOUNT. '
-Plan Chk. Dep.
Plan. Chk. Bal.
•-
Const. -
_
'
- • -
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
'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 or sale.)
Plumbing
• ❑ I, as owner of the property, am exclusively contracting with licensed. contractors to con-
struet -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..53-
-
such projects -with a contractor(s) licensed pursuant to the Contractor's License Law.)
• O I am exempt under Sec.- .B. & P.C. for this reason
Grading
-
Driveway Enc.
_ _ ... .
Date 130 'Owner - r f��
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, or a certified copy thereof: (Sec. 3800, Labor Code.)
Policy No. Company
O. Copy is filed with the city.. ❑ Certified copy is hereby furnished.
TOTAL'
CERTIFICATE OF EXEMPTION FROM
WORKERS'. COMPENSATIONINSURANCE
REMARKS
- -
.(This section need not be completed if 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.
- •
„ e .
�,'t} k.ft,�3t a t ;! 1 t3.,' �, CiY•a r%
' Date Owner
-NOTICE TO APPLICANT: If, after making this -Certificate of . Exemption 'you_ should' become
subject to the Workers' Compensation' provisions oh the Labor Code, you must -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.,Lin.e
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 from PfOperty,Llne
Lenders Name
Lender's Address
FINAL DATE
''Issued by: -'--Date
Validated by -
INSPECTOR
y q
b Permit-
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it 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 and state laws relating to building
construction, and hereby authorize representatives -of this city to' enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
Validation: -
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST 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 APPJEQUIP.
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.
SQ. 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 PLUMB NG
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. Ll� 00
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 SIGNATURESIINITIALS.
GARDEN WALL FINAL