06297 (BLCK)P.O. BOX 1504 N o . 06297
.97 ,
Building 7&105 CAL"LE ESTADO
Address X84? Southern Hills LA QUINTA,.CALIFORNIA 92253 ;
Owner
8'ti0lls3l L&}1d $ Mortzage, � " - BUILDING: TYPE CONST. OCGRP.
Mailing' C: .
Address 42-600 Cook. St., Suite 200 A.P. Number' ` M 16'est.> ase 19-B
City Zip Tel:
ialn Desert 922( .568.720M. „ Legal_ Description
i .. •
Contractor' - 2.,700 1f of £tf Firma: ttlock W,.At
SiiLli�,tr 6 * Ca'!vany Project Description
's
' .,.,Address
Same
:,�
`
City.
Zip
Tel.:
State Lia r • 288130
City 208 .
:.
& Classif.
Lic. #
Sq.'Ft.
a -No. No. Dvil :'
Size
Stories Units
Arch:, Engr.,
New ❑ Add'❑ Alter ❑ Repair ❑ r `•Demolitjon ❑
Designer
Address
Tel.
City
Zip
State
_
Lic. #
y
«:
• LICENSED CONTRACTOR'S DECLARATIONl
I hereby affirm ttdt.l •am licensed
under provision's of Chapter 9 (commencing with Section
Division 3,of the Businpe"ss•andi.Professidns Code, and my`license is in full force
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and
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.str sf'`._..a/t,w j.,r.-"t. _..fa•'`i- ::.turf I' �''.C`...s''C�.'7
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SIGNATURE / F / i' v^ .r' DATE
. ;1' •!l OWNEWBUILDER DECLARATION "' r
1 hereby 1
Estimated Valuations S �
affign'that am,exempt from the Contracfors License Law for the following
• reason: (Sec. 7031.5,Business�arxf Professions CoifeerAny city or county which requires a
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permit to construct. aHei,' brprove demolish, or repair any structure, prior to its issuance also
• requires the appricard for -such pennit-Jo.rite a signed statement that he is licensed pursuant to
the provfsions of the'Contrictor's,-License Law, Chapter 9 (commencing with Section 7000) o/
PERMIT
AMOUNT,
Division 3 of the Busoress'and-Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption."Any°vietation'of Section 7031.5 by.'any for
Plan Chk. Dep.
--J
applicant a permit'
• subjects the appbcant to a civil penally of not more than rive hundred dollars ($500).
Plan Chk. Bal.
-
❑ I, as owner of the property,.or my. employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const: --
c
Professions Code: The' Contractor's. License Law does not apply to an owner of property who
,
builds or improves' thereon and who does such work himself or through his own employees,
Mech.
.
provided that' such irprovements. are not intended or offered for sale. If, however, the building
Electrical •
'� _ -
or improvement is sok/ within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
PIUfTlbing
I
_I,
❑ I, as owner of thero
p party, am exclusively contracting with licensed contractors to con-
i`i struct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of who builds or improves thereon, who for
S.M.I. -
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5
property and, contracts
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Y
Grading
❑ 1 am exempt under Sec - B. & P.C. for this reason
Driveway Enc.
'
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
. I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker ,Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy NO.Company.
❑ Copy is filed with the city.." ❑ Certified copy.is hereby furnished..
i
TOTAL
• C KERS' ATE OF SATION IN FROM
• • . WORKERS' COMPENSATION INSURANCE '
REMARKS , -
', i•,nr' A'fy,.s _ ;,•r, , , fi ,;,« _ .;;y;,, --_(, ;,• -0
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Liz •'°''.s�f:'t�^ ::fur,.
- (This section need not be, completed if: the permit is for one hundred dollars ($ 100)' valuation
• or less.)'
..
ti
I certify that in the performance of tho work for which this permit is issued, I shall not,
employ any penton in any manner so as to become subject to the Workers' Compensation'
' Laws of California
+ . ' Date ' Owner '
•NOTICE
ZONE:
BY:-
TO APPLICANT: B, after.making this Certificate -•of Exemption you should become
-, subject to' the Workers' Compensation provisions of the Labor Code, • you must forthwith
comply wrlhSuch Provisions orthis permit shall bedeemed revoked. ••
-
Mlnlmum.Setback Distances:.
Front Setback from Center Line
i
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
-Lenders Address
FINAL DATEINSP/ECTOR
�i 13c�� t r
This is a building permit when properly filled out, signed and validated, and is subject to
s expiration if work thereunder is for 180 days. _
suspended
I cern that I have read this
ty application and state that the above information is, correct.
• Issued by:
Date Permit' `
1 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-.
` T
mentioned property for inspection purposes. .� • -
Validated 6y:''
'
t:
Signature of applicant f a Date'
,
Mailing Address
Validation:
.I+
City,. State,` Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. @
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. @
GROUT
WATER HEATER
DRINKING FOUNTAIN.
WALL SQ. FT. @
FINAL INSP.
BOND BEAM
WATER SYSTEM
URINAL
SQ. FT. @
GRADING
cu. yd.
$ plus x$
=$
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
/
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
INSULATIONISOUND
SQ.FT.GAR @ 3bc
HOUSE SEWER
FINISH GRADING
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 TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
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.
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
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