05411 (CRES)Building j
' Mailing
Address
City
Contractor
City.
State Lic.
& Classif.
Arcn., tngr.,
Designer
Address'
P.O. BOX 1504 No.
j 78-105 CALLE ESTADO
77 t .
L_L ;l�j ;E LA QUINTA, CALIFORNIA 92253 '
BUILDING: -TYPE CONST. OCC: GRP.•
A.P. Number —7 171—o — o Z3`
Zip Tel. !
le � fi
1v ti. Legal Description' % •
` Project Description PA 12, dY `, fz'" '1i0
TeI.:.
City
Lic. #
s
Sq. Ft. No.
Size . - -- Stories
New ❑ ;Add ❑
i
1
Alter ❑
t No. Dw. - <
'Units'
Repair.0 if • Demolition ❑
City
Zip
State
Lic. #
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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.
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4 ,
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SIGNATURE DATE
' OWNEWBUILDER DECLARATION',
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 u`
permit to construct, after, improve, demofish, or repair any structure, prior to its issuance also e
requires Ole applicant for such permit to ffte•a signed statement that.'he is licensed pursuant to =
the provisions of the Contractor's License Law; Chapter 9 (commencing with Section 7000) of '
Estimated Valuation < :!
X, I' '
PERMIT - wAMOUNT • -
a'.
Division 3 o 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
subjects the applicant to a cin?;
penally of not more than five hundred dollars.($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will r
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 -
••
Plan Chk. Dep. -
-
-
Plan .Chk. Bal.
Const.
Mech. -
' .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
EIBCtfICal' '- • . - v-�• ` tti a<, -
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 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.)
❑ 1 am exempt under Sec -B. & P.C. for this reason
-'
Grading
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
r
I hereby affirm that I have a certificate of consent to self-insure,'or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Y I� f
Policy NO Company
❑ Copy is filed with•the city. ❑Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE '
• (chis section need not he completed i/ the permit is for one hundred dollars. (5100) valuation
' or less.)
I certify that in the perfomlance of thg 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
REMARKS _I!
..t
" bate Owner
NOTICE TO APPLICANT: ft, after making this Certificate of Exemption you should become
subject' to the workers' compensation provisions of the Labor Code, :you must forthwith
comply with such prmrisionsorthis pennit shaft bedeemed revoked. -
w;
ZONE: < ' BY: -
Minimum Setback Distances:,`
T
Front Setback from Center Line
`
Rear Setback from Rear Prop. Line ')
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. (Sed. 3097, Civil Code.) - % •
Lenders Name
Side Street Setback from Center Line -
<
Side Setback from Property Line • •' _ "
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Lenders Address
FINAL DATE -INSPECTOR -
r
Issued by:• Date Permit
-y'
Validated by:
This is'a building permit when property filled out, signed and validated, and is 'subject to'I`.
expiration if work thereunder is suspended for 1130 days.
I certify that 1 have read this application and state that the above informatioriis'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. _ .f
Signature of applicant Date
Mailing Address
City.. State, Zip
w ,,
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. ®
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. Sp. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL Sp. FT.
=$
LUMBER GR.
FINAL INSP.
URINAL
SO. FT.
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING'
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIREPLACE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
CERT. OCC.
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
F REINF S
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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