04176 (CGAR)04176
P.O. BOX 1504
Building "► EI -335 -Terra Cotta tit 78-105 CALLS ESTADO F
Address LA'QUINTA; CALIFORNIA 92253,
Owner Bouldiv* bard `.DevelS>pk3nt
BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address 777 S, lin St e
."
- Si`✓ ite 10£
4l';3 '4'i9(i�'001
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
,
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r � , .• �
A:P: Number'
-
the alleged. exemption. violation of by applicant a permit
subjects the applicant to a civil penalty of not more than live hundred dollars (8500).
City
p
'D I, as owner of the property, or my employees with wages as their sole compensation, will
,Plan
e
do the work, -and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
721
OX"angek92686
Professions Code: The Contractor's License Law does not apply to an owner of property who
T7i4T5A7-T4056
,
Legal Description
Mech.
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3p i b% V
Contractor
Project Description'"'
or improvement is sold within one year of completion, the owner -builder will have the burden
an
44.76
of proving that he did not build or improve for the purpose of sale.)
,I
• O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Address
75 0'00
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.
4.59
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
-
❑ 1 am exempt under Sec. B. & P.C. for this reason
City
Zip
Tel.
Date Owner --
Infrastructure
a'yJ '
�Lnqao" Lt wrd. y�t
No. Dw.
State Lic.,
f. 4628 Y4
City
Lic. # .. .., ...
9 ,. .
Sq: Ft,
No.
1
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Size
Stories
Units
Arch., Engr.,
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
Designer
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Address Tel.
City s=?t.Y 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-';:
F
SIGNATURE ~' - DATE.
OWNER -BUILDER DECLARATION '
I hereby affirm lhat'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
IiissCluded
Estimated Valuation 2
2
permit to construct, atter, 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
.. -
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
-.AMOUNT
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for Any Section 7031.5 'any for
Plan Chk. Dep.
-
the alleged. exemption. violation of by applicant a permit
subjects the applicant to a civil penalty of not more than live hundred dollars (8500).
Chk. Bal.
- - - 15
'D I, as owner of the property, or my employees with wages as their sole compensation, will
,Plan
e
do the work, -and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
to
331,V �} '
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.
g �y t�
3p i b% V
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
44.76
of proving that he did not build or improve for the purpose of sale.)
,I
• O I, as owner of the property, am exclusively contracting with licensed contractors to con-
- Plumbing
75 0'00
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.
4.59
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
-
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner --
Infrastructure
a'yJ '
�Lnqao" Lt wrd. y�t
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
1
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
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❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
This section need not be completed if the
( permit is for one hundred dollars /5100) valuation
t L�
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. -
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Jh
APPLICANT:O
NOTICE If, after making this Certificate of Exemption you should become
ZONE:
BY:
subject to the ,Workers' Compensation provisions of., the Labor Code, you must forthwith
Distances: "
-, comply with such. provisions or this permit shall be deemed revoked.-
Minimum Setback -
•
Front Setback from Center Line
_
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
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
INSPECTORs4
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
1x
mentioned property for inspection purposes.
'
Yp '
•
Signature of applicant'- - Date
Ir
Mailing. Address- r.
Validation:
City, State, Zip
_7 �; '�-• '. ,:.WHITE - FINANCE, PINK APPLICANT, GREEN- BUILDING,
ice. < . _ .. , y,.'7 r,<- .,••.fs's•`..r _ # .. .. ,<;,Lr .�' , f�+'_�.
GOLDENROD - ASSESSORS OFFICE, HARD COPY- FILET D +
, � _ . r== .. . � - . i r ..., _ '_ •� � , ��''.
--
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT (p i
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB
YARD SPKLR SYSTEM
2ND FL SO FT. a
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR SO FT of
ROCK STORAGE
OUND. REINF. /�
1
GAS (ROUGH)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. 0
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SO FT. @
GROUT
WATER HEATER
DRINKING FOUNTAIN
WALL SO, FT. 0
BOND BEAM
WATER SYSTEM
URINAL
SO. FT. a
'
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP 6
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTONDISHI
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIREPLACE
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 g I V. c
SEWAGE DISPOSAL
SO.FT.GAR (g V:c
HOUSE SEWER
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 8 AIR COND. SOLAR
SETBACK
GROUND PLUMBIN
t
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
OUND. REINF. /�
1
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
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 6
AMING
FINAL INSP.
OOFING > -ry
//
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
MARK ARRESTOR*
A . FIREWALL Z
LATHING
MESH
INSULATIONISOUNDZ
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
,
GARDEN WALL FINAL :d