002052 (SFD)Building
Address
Owner
Mailing
Address
City Zip Tel.
Contractor
P.O. BM 2288
City • ,
State Lic.
& Classif. f 10, t
Arch., Engr.;
Designer
Address
P.O. BOX 1504 No. -02452
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Zip... Tel...
9220 564:,-."2228
t }} City
Lio. #�'r
Tel.
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number
Legal Description ` 3
Project Description
ISq. Ft. No. No. Dw.
Size Stories - -Units
New EL Add ❑ Alter ❑ Repair ❑
Demolition ❑
��; gasp U '
City
Zip Itate
. .... . .. . . ..
ic. #
LICENSED CONTRACTOR'S DECLARATION.
as 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing -with Section
7000).
h
of Division;�3tcof the Bu�ssiness and Professions Code, and my license is in full force and
ge 3,
effect. 1,..�.i�`T�F.".+.^
SIGNATURE+�- `DATE
_
' OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License law for the following
r
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 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 Professions Code, or tKAt:'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 ($500):'
Plan Chk. Bal.
❑ 1, as owner of the, property, or my employees with'wages as their sole compensation, will
'
.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
const.
Professions Code: The Contractor's, License Law does not apply. to an owner of property who
.
.
builds or improves thereon and who does such work himself or through his own employees,-
M@Ch:'
_ -
'
provided that' such improvements are -not intended or offered for sale. If, however, .the building-
,
or improvement is sold within one year of completion, the owner -builder will have the burden--
Electrical
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
12.00
- struct the project. .(Sec. 7044, Business and Professions Code: The Contractor's -License Law
does not apply to an owner of property who builds,or improves, thereon, and who contracts for
S.M•1• •••
-
• such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
..
Grading
0 I am.exempt under. Sec. -B. 8 P.C. for this reason
Driveway Enc.
Date Owner.
Infrastructure
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have a certificate or consent to seWinsure, ora certificate of.
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O. Copy is filed with the city.. ❑ Certified copy is hereby.furn!shed. .
TOTALS#
CERTIFICATE OF EXEMPTION FROM
REMARKS.
WORKERS' COMPENSATION. INSURANCE
(This section need not be completed if the permit is for -one hundred dollars' ($ 100) valuation
- -
or less:) _ ...
certify that in the performance of thg work for which this permit is issued, I shall not• r
. 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, 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 thele 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
INSPECTORS=-
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.
(.certify that I have read this application and state that the above information is correct.
Issued by:
Date '~� Permit
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.?3 �.^"^►7S✓'' { Date
Mailing Address r4 r
Validation:
City, State, Zip
A42"%0
..2 18 1200
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. p
GAR. SQ, FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRYTRAY
AIR HANDLING UNIT CFM
GAS (ROUGH)
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.
SQ. FT. p c
BATH TUB
t
WATER HEATER
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
BOND BEAM
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GRADING
cu. yd.
$ Plus -X$-=$
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
/ ($ROUND PLUMBING".
LUMBING
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
i
FINAL
TEMP. POLE
GROUT
t
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ Plus -X$-=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
C
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL