003154 (BLCK)Building
Address
Mailing
Address
City
ress
52 -CSS' Avenida Vallejo
t;O:t;'f'ado Marquez
v
Zip
Tel.
P.O. BOX 1504 `. No, 003254
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 773-222-015
Legal Description
Project Description i2r�tPat3rsc�ar'!:f i°' X I9 idin_tt
' City - .. , .
Zip
Tela..
State Lic.
City
& Classif.
Lic. #
Sq. Ft.
No. No. Dw.
Size
Stories Units
Arch.; Engr , _
' Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
CityZip
State
Lic. #
^
LICENSED CONTRACTOR'S DECLARATION .
I hereby affirm that Item 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
I hereby affirm that I am exempt from the Contractor's, 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
.requires, the applicant. for such permit to rile a signed statement that he is licensed. pursuant to
. -the provisions of the Contractor's License Lawp,Chapter 9 (commencing with Section 7000) of-
' 'Division3 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
Estimated Valuation
PERMIT
.. ..
AMOUNT
�Plan.Chk.-.Dep. '-
- '
' subjects the applicant to *a civil penalty of not more than five hundred dollars.($500). ' .
• ❑ I, as owner of the property, or my employees with wages as their sole compensation; will
Plan CFik., Bal. ; ,
Const.
's��3
c
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
"'
Mech.
builds or improves thereon- and who does such work himself or throughhis own employees,.-
., provided that such improvements are, not intended or offered for. sale. If, however, the building
EIQCtrICa.I'
'
'
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 do the. Contractor's License Law.)-
❑ 1 am exempt under. Sec. B. & P.C. for this reason
x
Grading
Driveway Enc.
Date f �i�- V- 7Owner ; v,� ..•I ,f"� 1 a �">yr 1`^�* ��
Infrastructure
WORKERS' COMPENSATION DECLARATION
' I' hereby'affirm that I have a'certificate of consent td'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
$20,00
CERTIFICATE OF EXEMPTION FROM
• WORKERS' COMPENSATION INSURANCE ..
REMARKS
-
y x r.• nr;, A— r r •tr A ^4 6 .r ..Fw
(This section need not be completed if the permit is for one hundred dollars ($900) valuation
.. or less.) .. _.- .. .. _
I certify that in the performance of tha 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.
rw .r x �, tvs� - t•j 1 �.
°r' + i� S ,y t i3�) i 110100,-,
' Date " 'Owner'
NOTICE TO APPLICANT. If, 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 provisions or this permit shall be deemed revoked. - --
ZONE: BY:
Minimum -Setback Distances:
Front.Setback.from.Center Line
Rear Setback from. Rear Prop. Line
CONSTRUCTION r 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, Civil code.)
Side Street Setback from Center Line- '
Side Setback from Property Line
Lender's Name
FINAL DATE
Issued by: `
'Validated by:
INSPECTOR
Date Permit
Lender's. Address
ThisAs'a'building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify 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
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
A.C. UNIT
2ND FL. SQ. FT.
SLAB GRADE
YARD SPKLR SYSTEM
POR. SO. Ff. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
ROUGH WIRING
DRAINAGE PIPING
WALL SO. Ff.
DUCT WORK
DRINKING FOUNTAIN
SQ FT. ®
GAS (ROUGH)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
REINF. STEEL
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
SERVICE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
WATER SYSTEM
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. Ff. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FIRE ZONE ROOFING
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 PLUMB NG
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
^
901 OUND. 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
EC
}
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