09231 (BLCK)Building
Address
Owner
Address
City
. La
Contractor
P.O. BOX 1504 N 0 . V_
78-105 CALLE ESTADO �^
LA QUINTA, CALIFORNIA 92253{
BUILDING: TYPECONST.' 'OCC: GRP.
SAMA-- A.P. Number
Zip Tel.
345-0450 Legal Description
Project. Description"
es a �t£� Trends! AA . S * .uF. 49 .9 ...t^Tr ms= I 4
Address . , ,
City IZ1p
State Lic.
& Classif. CS35 0471
Arch., Engr.,-
Designer +•
_JLU
Tel.:
City
Lic. # 1428 Sq. Ft. No. No. Dw.
Size • Stories - - Units.
New ❑ Add ❑ Alter ❑ Repair ❑
Address
Tel.
City
Zip
State
Lic. #
' LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing. with Section
70p0) of Division 3 of�the Business and Professions Code, -and my license is in full force and'.
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,
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JSIGNATURE-—''�'\*rC.•'• 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 toconstruct, after„ improve, demolish, or repalr,any structure, prior to its issuance also
requires the applicant for such permit to file a. signed statement that he is licensed pursuant to
Estimated Valuation
-
tl piR v ^
A 04i
V •nV V
•.
PERMIT ..
i ,.
-AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
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- Division 3 of the Business and, 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.
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.subjects the applicant to a civil penalty of not more than five hundred dollars ($500). -
•�� wO.1, as owner of -the property, ormy employees with wages as their sole compensation; will
_: =do:tha work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness.and
`)`iRrofessions Code: ,The. Contractor's •License Law does not apply to an owner of property who
Plan Chk. Bal.
-
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Const.: .
3
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Mech. -
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if 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
r.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.):
Electrical
,
Plumbing
-
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
' strucl the 'project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds of Improves thereon, and who contracts for
S.M,I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B..& P.C. for this.reason
Grading
Driveway Eno.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
v:&
hereby affirm that I have a .certificate of consent Ito "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
A3. 28
CERTIFICATE OF EXEMPTION FROM
• WORKERS' COMPENSATION INSURANCE
REMARKS
-
(This section need not be completed if the permit Is -for one hundred dollars ($100) valuation
'or less.)
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,-
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~ t l+i'S +a $i s9 asr.`i a dS3r6"r 40
Icertify that in the performance of thg work for which this permit is issued, I shall notrwtis
employ any person in any manner so.as to become subject to the Workers' Compensation
Laws'California. r�r�/
Dafen ice_. °downer:.
' NOTICE TO APPLICANT: If Rer!•mak+ng this Certdicate 6f -Exemption you should .become.,,,._
'subject to the Workers' Compensation provisions of the Labor Code, -you must forthwith
comply with such provisions orthis permit shall be deemed revoked. •
- s�rr -�• rys u,•* w n r J
'•
_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, CivifCode.),
Side Street Setback from Center Line'
Side Setback from Property Line
Lender's Name
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.
FINAL DATE
INSPECTOR
_ ' 1 certify.that 1 have read this -application and•state that the above information is correct.
I agree to comply with all, city and county ordinances and stale laws relating to:,building
construction, and hereby authorize representatives -of this city to enter the” above-.
mentioned property for inspection purposes.
Issued by: -
Validated by:
Date Permit --
Signature of applicant Date
" Mailing Address
Validation:.
City, State, Zip
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r r •- r � -•r - ,.. fi S'.
r'ia � 1�- K t •rr , �3 .. . 'Y
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
2ND FL. SQ. FT.
COLL. AREA
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
FORMS
DRAINAGE PIPING
WALL SQ. FT.
ROUGH WIRING
DRINKING FOUNTAIN.
SQ FT ®
DUCT WORK
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
OTHER APPJEQUIP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GROUT
LAUNDRY TRAY
AIR HANDLING UNIT CFM
SERVICE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/.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
1
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
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM ^1 u
./
(� G
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
.$F
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
V
I
�. - . +�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
u
SPARK ARRESTOR
GAR. FIREWALL
LATHING
r
MESH
,
INSULATION/SOUND
{
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL