001544 (SFD)oo�
Building
Address
P.O. BOX 1504 No,' -001-544
78-105 CALLE ESTADO
„ P,4e,r.t% r
4C LA QUINTA, CALIFORNIA 92253
OwnerGenw
- • -
-
'PERMIT:
-
al mmagemmt cbm
BUILDING: TYPE CONST.
V N OCC: GRP. R 3.
` Mailing
Address
_
1001 BLSbcp St- SUe 2700
02.24
Const; ...
A.P. Number
Mach..
City
37.00
Zip
Tel.
60,
' Plumbingl,.fft'
Ecdwlulu
96813
I—SOI —367. 5054
Legal Description
5.46
Grading
Contractor1
Project Description
FaUs.
ai.�r• I4►arg� tierx
Fatty' z'w
t- as s'33r ,
with, CMm Dew L. Mvect=
_
146' � �•e
Address
-,•:
P*OA BM 173
TOTAL .
City
.. ....
Tel:..lzip.
92 333
3'4 U',
State Lic.
City
Mn1247
& Classif.
�d.�22
Lic. #
Z�7
S Ft.
� ���.....
No. No. Dw.
Arch:, Engr.,
- -
_
Sq ey _ .
Stories � ..� . .Units r .. . .
`
Designer
New .I@ Add ❑
Alter ❑. Repair ❑ Demolition ❑
Address Tel.
City Zip State
pz . 92262 Lic. # .....
..� .
LICENSED CONTRACTOR'S,DECLARATION y
I hereby affirm that Ilam licensed under provisions of Chapter 9.(commencing with Section jQ
7000) of Division 3 ofgthe)Blulsi
inness and Professions Code, and my liceris/e iiss;imfull force and
effect -,: "
SIGNATURE DATE
OWNER -BUILDER DECLARATION' "
I hereby affirm that I am exempt from the Contractor's License .Law for Ahe following
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, Chapter9 (commencing with'Section 7000) of.
Division 3 of the Business and Professions Code, or that,. he is exempt therefrom; and the basis,
forthe alleged exemption. Any violation of Section 7031.5 by any applicant for a..permit'
subjects the applicant toe civil penalty of not more than five'hundred dollars'($ 500).'- - . ' 4 '
❑ I, as owner of the property, or my employees with wages as their sole compensation; will
do the woik,,,and the structure is not intended or offered for'.sale. (Sec' 7044,. Buisness and
Professions Code: The Contractor's License taw does not .apply' toan owner -of property who
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, ,thea 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.) ' . -
.0 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•ofproperty who builds or improves thereon, and. who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am.exempt under Sec. B. & P.C. for this reason -
Date Owner
WORKERS' COMPENSATION DECLARATION
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 '
0 Copy is filed with the city. , ❑ Certified copy is hereby furnished. .
CERTIFICATE OF EXEMPTION FROM
. . WORKERS' COMPENSATION INSURANCE.
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
or -loss.) . .. . _ ., . _ ._.. .. .
I certify that in the performance of the 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.
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. '
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.), .. -
Lender's Name
Lender's Address
This is'a building permit when properly filled out, signed and•valldated, 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.
I agree'to comply with -all city and county ordinances and state'laws relating to building
construction, and hereby authdrize representatives'�of'. this city - to . enter the above-;
mentioned property.for inspecttii6n purposes.
Signature of applicant /� + a� i .:f 1 x' Date xf D1
Mailing Address + '
City, State, Zip
HARD COPY
Estimated Valuation
77A94.8400
'PERMIT:
-
AMOUNT
Plan Chk. Dep.
105.72
Plan Chk. Bal..2
02.24
Const; ...
...
Mach..
37.00
Electrical
60,
' Plumbingl,.fft'
-
S. M.I.
5.46
Grading
Driveway Enc.
Infrastructure
Fatty' z'w
t- as s'33r ,
with, CMm Dew L. Mvect=
TOTAL .
$62.60
"MAS
REMARKS
ZONE: BY:
'Minimum Setback Distances:
Front Setback from Center.Line
Rear Setback from Rear. Prop. Line
Side Street Setback.from.Center Line:
Side.Setback from' Property Line
FINAL DATE INSPECTOR'
Issued by: 'Date ----------------
Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FESS
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE _
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
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
LAUNDRYTRAY
AIR HANDLING UNIT CFM
I
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
GAR. FIREWALL
SO.FT.GAR Q 3/ac
HOUSE SEWER'
LATHING
GAS PIPING
PERMIT FEE
•
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MF_CH.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.
•r
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
M
$ 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 SIGNATURES/INITIALS
GARDEN WALL FINAL