002166 (SFD)vz
w� �Qut�fw
P.O. BOX 1504
No. • �� 2166.
'Building g i 78-105 CALLE ESTADO
�`
Address LA QUINTA, CALIFORNIA
92253
Owner
BUILDING: -TYPE CONST: OCC..GRP. r •'
Mailing
Address 75-005 0MMtrV C 3 M.
A.P. Number
_
City
ZipTel.
Palm
,. .gO
.56$,,,2$28•.
Legal Description
Contractor "Project
Description
'
. NVII&
Address .... .. ......... `.!
,Sam
City . ,• . .... .Zip
..
Tela .
ngrxa
State Lic.
City
& Classif. 288130
Lie. # . 328
Sq. Ft.
No. No. Dw. ?
„ «
Size
Stories- - Units
- --Arch.; Engr..
Designer :
New ❑X Add ❑
Alter ❑.: Repair ❑'-' Demolition ❑
Address
Tel.
Mm powx for Sewer Uf statim
City
Zip
State
Lie. #
A 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'forceiand""
effect. - �
g.__.:l > .r•e..: f^ rr . f„ , �'i': v F • .Y , err v f .
'
SIGNATURE DATE
-
OWNEWBUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractors 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
• -t-requires the applicant for such permit to file.a signed statement that he 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 Piofessions Code, or. that. he is' exempt therefrom, and the basis
for the Any Section -7031.5-by, 'any for
Plan Dep.
-
alleged exemption. violation of applicant a permit
subjects the applicant to'a civil penalty of not more'thani've hundred dollars ($500). '
.Chi(.
Plan Chk. Bal;
- '
.l'7 I,_as.ownerof the property, or my.employees with,wages as their sole,compensation, will.
do'the work, and the structure is not'intended or offered for sale: (Sec.. 7044, Buisness and
COr1St,
r
. 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
C q�
500
. 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
O Lam exempt. under Sec. - B. R P.C: for this reason
Driveway Enc.
Date • owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
' I hereby affirm that'I have a certificate of consent to selVinsure;'or a certificate of `
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
-
Policy No. Company
O Copy is filed with the city... O Certified copy is hereby furnished.
'
TOTAL
. UU
CERTIFICATE OF EXEMPTION FROMREMARKS
'
WORKERS' COMPENSATION INSURANCE > .-
.
(This section need not be completed if the permit is for onehundred,dollars ($100) valuation
-
or less.) .. .. ... . _ .. ...
_
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, alter making this Certificate of Exemption you should become
ZONE:- -
BY.
' subject to' the Workers' Compensation provisions of'-the'Labor Code,- jou`must lorlhwith
-MinimumSettiack Distances:
comply with such provisions or this permit shall be deemed revoked.
- -
Front Setback.from Center Line
Rear Setback from Rear.Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback:ffOm'.Center.Llne
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 fromProperty Line ,
Lenders Name
Lender's Address
"signed
FINAL DATE '
INSPECTOR' •' -
' ThisAs a building permit when properly filled out, and validated, and is subject to
,'
expiration if work thereunder is suspended for 180 days.
y
3 1
.1 certify that I have read this application and state that. the above information is correct.- '
"I
Issued by:'.-
Date ' Permit. -
agree to'comply with all city and county'ordinances-and slate 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 `y -+' ��i''. 6 Date
. Mailing Address
Validation:
City, State, Zip r/
A4b90
3 •11 35,G0 Sl
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
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 (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP.IEQUIP.
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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
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 FANK
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
-
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