003892 (BLCK)f .. 4 _ r
Building.
Address 51-343 vallejQ
Owner
Francisco & Elva"
Mailing
Address P_ 0- lgnv Jif
City Zip
La: Quints 92253. .
Contractor
Address
44
P.O. BOX 1504 No. 003892
78-105 CALLE ESTADO
LA QUINTA, CALIF,ORNIA.92253 t
vela= ',ez '. `: ` �. " BUILDING:'TYPE CONST.-` ~ - OCC:'GRP.,•
A.P. Number 173-093a-01£
Tel.
"564T2076•„� Legal Description
4 Project Description Block And OA fenea
Zip Tel:. ... .
State Lic. City
& Classif. Lic. # Sq. Ft. No.
Arch.,' Engr:; Size Sto
Designer' New ❑ Add ❑
Address Tel.
City Zip State
Lic. #
4, 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 force and
effect.. ..
SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractors License Law for the following - `g
reason: (Sec. 7031.5,Business and Professions Code; Any city ocounty which. requires a
permit io consr construct, alter, improve,. demolish, or repair -any structure, 'prior to its issuance also .
requires the applicant for such permit to rile a signed statement that.he.is licensed pursuant to PERMIT -
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.-
Alter ❑
' subjects the'applicant to'a civil penalty of not more than.five hundred dollars .($500). `^,
❑ I, as owner 0f.the property, or my employees with wages as their sole compensation, will
Plan Chk. Bal.
COnSt.'
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
_Mebh.
. builds or improves thereon and who does such work himself or through. his own employees, .
-, provided that such improvements are not intended or offered :for sale. If, however, the. building.:
;Electrical
or improvement is sold 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.)- . .
-Plumbing
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business anddProfessions 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.L. -
' such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)..
O 1 am exempt under Sec. .B. 8 P.C. for this reason
Grading
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
O. Copy, is.filed with the city. _ . ❑ Certified copy is hereby furnished. .
TOTAL
No. Dw.. 7
Units
Repair ❑ . Demolition ❑
AMOUNT..
r CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i1 the permit is for one hundred dollars ($100) valuation
or less .. .. ;t�,Li3 3T�a1�r�1 ai' ;:'i,'�, � ,'�i;:i'�,i: Ca"ir#•.'i ..;r� a flS.! �..'3
I certify that in the performance of thg work for which this permit is issued, I shall not -
employ any person in•anymannerso as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after 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 deenied.revoked.Minimum Setback Distances: -
Front Setback from Center I
CONSTRUCTION LENDING AGENCY
. I hereby -affirm that there is a construction lending:agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civi(Code.).
Lender's Name _
Lender's Address ,
' 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.
tcartify that I have read this application and state that`the above information is correct.
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. ;
Signature of applicant Date
Mailing Address
City, State, Zip
Rear Setback from Rear Prop. Line
HARD COPYI
Side Street,Setback from Center Line
Side Setback from Property, Line,
FINAL DATE
INSPECTOR
Issued b
261,88
- Date `' -Permit
Validated .by:
Validation:
HARD COPYI
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
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 I
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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. ®c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR Q 3/ac
HOUSE SEWER
REMARKS:
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 APP.IEOUIP.
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 SIGNATURES/INITIALS.
GARDEN WALL FINAL
la