07416 (SFD)r • I C i
P.O. BOX 1504 N o . 0:7416 �
Building 78-105 CALLE ESTADO
Address 55- Southem HfIls LA QUINTA, CALIFORNIA 92253 a.
Owner 1
BUILDING`.• TYPE CONST. OCC: GRP.
Mailing
Address a �. _9no A.P. Number ia �� lid
City Zip Tel.
Pa9f 9 Legal Description
Contractor, _, Project Description ' ;ftct 2S.500-1 Pian 2d
1.
Mtio al d .& Mortgage
Address
same :.. S 4
City Zip Tela
My
State Lic. City
& Classif.Lic. # Sq. Ft. No. No. Dw.
_ YH_ Size 1�1 Stories'Units
Arch., Engr., :. _ . a - ....._
Designer - New ❑ Add ElAlter ❑ Repair ❑ Demolition p
Address Tel.
City - a: Zip State
Y'; Lic. #
LICENSED CONTRAC.T,OR'S.DECLARATION -
11 hereby affirm that tam licensed under• provisions of Chapter9 (commencing with Section
700 0) of Division 3.of'the Business an&Profess� s Code*tand•my license.is'in fulhforce and
effect.
_SIGNATDRes' • -"-•" d$ -"DATE
1. OWNER -BUILDER DECLARATION
I hereby affirm tfiat`I am exempt from the Contractor's License Law for the following Estimated Valuation
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 file a signed statement that be Is;licensed pursuant to PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of • '
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.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). t
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
• do the work, and the.structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.. '
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.)
_ ❑ I, 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.)
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
'Date Owner Infrastructure
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
❑ 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_, l00) valuation
or less.) ,,,,r!��+- -`•� '
I certify that.in the performance of thg work -for. whicFi'tips"permi s issued, kshall not
employ any person in any manner so as to become subject flbb.. a Wor rs' Compensation
Laws of California., ' ti f ., 1 i
Date ilad.Owner ,Ri I A, J� ':* srz. .•. i
NOTICE :'TO A'PPLICANT:,;.lf,-_aflei nfakipg'.'this, Certificate of Exemption —you ZONE: BY:
subject 'to the Workers' Compensation provisions of the Labor Code, you must forthwith _
comply with such provisions or this permit shall be deemed revoked.t Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from.Center Line
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 INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it 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 f ermit
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-.
mentioned property for inspection purposes. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
UNITS
LAB GRADE - -�V
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGHy,-�3�
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEQUIP.
DRINKING FOUNTAIN.
SQ 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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING �/ 1
v
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
/ `! ^� �-
LAUNDRYTRAY
AIR HANDLING UNIT CFM'
REMARKS:-
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.
SO. FT. RESID @ 1+/e c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
MESH
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
OLIND PL -e�UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE - -�V
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR Sovvmeb
ROUGH WIRING,
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGHy,-�3�
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)!/
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
INAL INSP. /,?-
FRAMING �/ 1
v
FINAL INSP.
OOFING 7-
/ `! ^� �-
n
�v ,{/ �(�
'v
REMARKS:-
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
HING
MESH
SULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL