003277r
Building
' Address 79-290
Owner p1_1'A_i_4 p
Mailing .
Address
City
Contractor
Address
•-44
P.O. BOX 1504 No. 403277
78-105 CALLE ESTADO
as^c.t- Ridge LA QUINTA, CALIFORNIA 92253
Zip Tel.
)Unez .9220 345-•3521..
Ale Sn s � i"�a
Zi:pw. Tela
BUILDING: TYPE,CONST. 'OCC: GRP. .....
A.P. Number La C)_uiata . Pafts
Legal Description
Project DescriptionMove Washing Machine
State Lic.
City
& Classif.. 77SO7
Lic. # AQ
Sq. Ft.
Size, -
No. No. Dw.
..Stories .. Units. . -
Arch'., Engr., .. .. •- - - ..
Designer
New ❑ Add ❑$ Alter ❑• - - Repair ❑ .: Demolition ❑
Address
Tel.
" City
Zip
State
_....
Lic. #
'LICENSED CONTRACTOR'S DECLARATION.
"
hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the. Business andProfessions' Code; and my licenseis In full force,and
effect.
... .. ..
... . _. .. .
rSIGNATURE� iY i DATE
" f OWNER -BUILDER DECLARATION ! f
I hereby affirm that I am exempt -from the Contractors License Law for the following3iP�
• -reason: (Sec,, 7031.5,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
requires the•applicant for such permit to rile 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 the Business and* Professions Code, or thathe is exempt therefrom; 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).
_❑ I, as owner of the property, or my, employees with wages as; their sole compensation, will
do the work; and.thei structure is not intended or.offered for sale. (Sec. 7044, Buisness andr..COf1St.
Professions Code: The Contractor's License Law does,not apply to an owner of property who'
Estimated Valuation
-
T '
'�
-
-.:.PERMIT
-• - -
- -' AMOUNT
-
Plan-Chk. Dep..
..•
Plan Chk:. Bal.
Mech.
,
builds or improves thereon and who does such work himself or through his own employees,
provided. that: such improvements are, not intended or.oflered for. sale. If, however, the building
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
Citi
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
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.
_
• such projects with a contractors) licensed pursuant to the. Contractor's License Law.) - -
❑ I.am exempt under.Sec. B. 8 P:C. for this reason
Grading
.
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
' 'I hereby -affirm that' I have a certificate of consent to self -insure, ora ceitificate'oi
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
.Policy No: / % h >' `7 rCompany n .
.
(] Copy is filed with the.ci{y. _ O,Certified copy is hereby furnished. ' ..r
TOTAL
Egsu
REMARKS
CERTIFICATE OF EXEMPTION FROM
' WORKERS'.COMPENSATION.INSURANCE
(This section need not be completed if the permit' is for one hundred dollars ($100) valuation
or less.).. •. _ .. .. .. .. .., .. .. ..
certify that in the performance of the work for which this permit is issued, l shall not"lj
employ any person in-anymanner so as to become subject to the Workers' Compensation
Laws of California.
.
rl, a17" j
�r+a a J rLVU Yg .. .k +i
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 or this permit shall be deemed revoked. /
.'ZONE:
Minimum Setback
BY:-
-
Distances:
Front Setback.from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
hereby affirm that there is i coristiuction Iendirig�agency forthe 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
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 readAhis application and state that* the'above information is correct.
agree to comply with all city and county ordinances and state -laws rilatirig to building
construction, and hereby authorize representatives -of this city to enter the above:
mentioned property for inspection purposes. .
FINAL.DATE
Issued; by:
Validated by:
INSPECTOR'
m 7
�"'
Date 7 a Permit
.
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES l
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP.IEQUIP.
DRINKING FOUNTAIN
SO FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1114 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR Q 3/4c
HOUSE SEWER
LATHING
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
ROCK STORAGE
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
^
`UX LID
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL