07412 (SFD)••♦•}•
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;•I.y. t;i _ .ice, _ - _ ,+ ,.{ .;'Y.
P.O. BOX 1504 No. 0741-2Building }
Address �69i} th Hg• S „ , 78 105 CALLE CALIFORNIAESTAD9
LA QUINTA, ORNIA 92253 _
Owner ., �— A
.!kmrise COMM
Mailing �. �' _ BUILDING: TYPE CONST.' < OCC: GRP.
Address, • A.P. Number > S$ — s.e IM
City, r. Zip Tel: t
Legal Description
Contractor _ ' Project Description T", et, 9--titiIii%$Z-1 Plaw, 0
Address
0 EXEMPTION FROM
�• WORKERS' COMPENSATION I NSURANCE
REMARK'S—
(This section need not be completed if the permit is for one, hundred-dollars^(5.1,00) .valuation
-
City
v.: : ,
Zip
Tel.:
certify.that the performance of the work for which his permit is issued not
employ any- person in any, manner so as to become sybject to the W9jkers' Compensation
- it • -
State Lic.'
&Classify • 0
City
Lic: # 328
Sq. Ft. 1:515' ..
No. No. Dw.
,
=;
Size
Stories Units',
Arch.,' Engr.,
Designer-,
New ❑ :._Add ❑
r
Alter ❑- Repair ❑ •' :: -Demolition ❑
Address`_
Tel.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
City... `!'
Zip
State.
Lic:.#
I hereby affirm that there is a construction- lending agency for the performance of.the.
_ • _ LICENSED CONTRACTOR'S DECLARATION"
work for which this permit is issued. (Sec. 3097, Civil Code.)
'.
I hereby affirm that I.am licensed under provisions of Chapter 9'(commencing with Section
7000) of'Division 3 of the Business- and tRrofessiohs-Code, and my -license is in full force;pand
effect..'�` t
Lender's Name
,
.1
' SIGNATURE - %\ A. i DATE
` OWNER -BUILDER DECLARATION,
w
he
I.reby 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 to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the'appltcant for such permit to file 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 that. he is exempt therefrom, and the basis-
.for, the alleged < exemption. Any violation's of Section 7031.5 by 'any applicant for a permit
; . subjects the applicant to a civil penally of not more than five hundred dollars (5500).
r
' ••O'I, as'owner of the property, or my employees. with wages as,their sole compensation, will
Estimated Valuation
$11149M
-
PERMIT , -
r
v .r,l AMOUNT
Plan Chk.'Dep.
h -
Plan Chk. Bal.
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"Permit
' Const.
ache pem Ql" ESS
do the work; and the structure is' not intended or offered for sale. (Sec. 7044, Buisness and
. Professions.. Code: The Contractor's License Law does not apply to an owner of property who
Mech.
builds or. improves thereon and who does such work himself: or through his own employees,
that•�such improvements are not intended or offered for sale. If, however, the building
Electrical
••
" orimprovement is sold within one year or completion, the owner -builder will have the burden
• of proving that he.did not build or improve for the purpose of sale.)
Plumbing
5'
❑.I; as owner of the property, am exclusively contracting with licensed contractors to coh•
•+•Strutt 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
.such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
D I -am exempt under Sec. B. & P.C. for this reason
_
$.M.I.•_p,,
Grading
1
,
Driveway Enc. -
I -c..
Date owner
Infrastructure
r
,, .
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
- Worker's Conipehsation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No: , ' - 6 company
;
O Copy is filed with the city. O Certified copy is hereby furnished..
TOTAL
'
t
CERTIFICATE F
0 EXEMPTION FROM
�• WORKERS' COMPENSATION I NSURANCE
REMARK'S—
(This section need not be completed if the permit is for one, hundred-dollars^(5.1,00) .valuation
-
' or less.)
I in shall
certify.that the performance of the work for which his permit is issued not
employ any- person in any, manner so as to become sybject to the W9jkers' Compensation
k
' Laws of California.
f ..+.f ^ `` `i.s.• r:
Date 4..`;t"aQwner ; i%i r;._1
�4
NOTICE TO APPLICANT.'if,., after making this ':Certificate -of 'Exemption you shouttl�e
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.
...
Minimum Setback Distances:
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.)
Side Setback from Property Line
Lender's Name
1
Lender's Address
FINAL DATE
INSPECTOR
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.
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"Permit
I certify that I have read this application and state that the above information is correct.
Issued by:
Date
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
IST FL. SQ. FT. ®
UNITS
COLL. AREA
2ND FL. SQ. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
AS (ROUGH) Z(.��
/
DRINKING FOUNTAIN.
SQ FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ plus x$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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 ® 1+/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
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
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR'
SETBACK
OUND PLUMBING/ f
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER OR
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
UND. REINF(i —/ rl( 0
AS (ROUGH) Z(.��
/
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.
L INSP
RAMING
FINAL INSP.
OOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
VLTHING �r a
MESHnfkI
SULATIONISOUNDd �
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL