003897 (PAT)». P.O. BOX 1504 N. 0. 0038ST •.. .
Building 78-105 CALLE ESTADO
Address 79-304 13. Stet d ='' 1)`CA.QUINTA, CALIFORNIA 92253
Owner
FA i3oi3aitele
Mailing ;. ~. BUILDING: TYPE CONST.. OCC: GRP.
Address Deer) Canvon Drive y .A f ,.Number La Ouinta Palms
City Zip Tel.
kj3cTtF'..i5-iC Legal Description
Contractor x •-., .
Project Description Pat-in +(n,0Vk,r
Address.. ... `
City Zip . Tela..
State Lic: City
& Classif. Lic. # Sq. Ft: No. No. Dw.
•
Arch.,'Engr.i- .. .. .....
-Size Stories Units,
-Designer. New ❑' Add ❑ Alter ❑ :Repair ❑ " -Demolition ❑
Address Tel.
City 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. -
SIGNATURE DATE
OWNER-BUILDER DECLARATION Estimated V81UatlOn A
- I, hereby affirm that I ani exempt from the Contractor's License Law for the following ..q+tA a-$�.rLt
reasonc.(Sec. 7031.5,Business and Professions code:- Any city, or county which .requiies•.a, l80 _ ^
' permit to construct, alter, improve, demolish, or repair . any•structure, prior to its issuance also AMOUNT
L..
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 - - _ -
Division 3 bf the Business and Pioressions Code, or that. he is exempt ,therefrom, and -the basis-
-1or.-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 1 as oner of,the property, or my employees with wages,as their. sole compensation, will Plan Chk. Bal....
do {he work, and the structure is not intended or offered for sale: (Sec. 7044,,Buisness and.Ci011St. � r"D0
-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.'
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
of proving that he did not build or improve for the purpose of sale.)
0,1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing '
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 contractor(s) licensed pursuant to the Contractor's License Law:) -
OJ am exempt under Sec. BAIRC. for this reason r. a. Grading
Driveway Enc.
Date 41^ d-kk,,..Owner. -A�;' aA•R r � %d .-r Infrastructure
t'
WORKERS"COMPEN SATION DECLARATION
1 hereby affirm that I have a'certificate of consent, to self-insure, ora certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy Nb. ' ' ' Company
❑ Copy is filed with the city. O 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 (8100) valuation " • '.,r.;r;ax• a'.•-`,,:c�,. ,.:.x r�raaA, w;• kv r. r.r, - z>>P+ ,; - . -r
.. or less.) .. . . . . . . gr:<wr— A, fl. :=. V e- )tu e ^i.t.:r,.
certify that in the performance of thg work for which this permit is issued, I shall not +Y
employ any person in any manner so as 4o become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: ' - BY: r
subject to the Workers" Compensation provisions - of: the Labor Code, you must forthwith- -
comply with such provisions orthis permit shall bedeemed revoked.• Minimum Setback DlstaflceS: .. -
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.)'; , - -$Ide,$etbaCk from Pfoperty Llne '
Lender's 'Name
Lender's Address
This'is a building permit'when properly filled out, signed and validated,'and is subject to FINAL DATE INSPECTOR
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:DatQl.�19CPermlt
agree to comply with'all city and county ordinances and state laws relating to building. 3 .
construction, and hereby authorize representatives ,of this city to enter the' above-.
mentioned property for inspection purposes. Validated by:
Signature of applicant Date
Mailing Address •Validation:
.City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. p
CAR P. SO. FT.
WALL SO. 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 APPJEOUIP.
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
A
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SO.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE TLUMB. 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 APPJEOUIP.
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
A
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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