002383 (AR)P.O. BOX 1504 NO:U Z5DJ
Building 78-105 CALLE ESTADO
Address J2 .34, Aver Rl" V` Ueio
LA QUINTA, CALIFORNIA 92253
Owner .,
Jim somx1lew
Mailing....
Address
City Zip Tel.
Contractor
Address �.....
State Lic.
& Classif.
Arch.; Engr.,
Designer
Zip " " "" ' Tel:
City
Lic. #
BUILDING: TYPE CONST. OCC: GRP.' ' .
A.P. Number 773-2223"00'7
-564--3471D . Legal_Description lot 16' .
Project Description
Sq. Ft. 90� No.
Size.. �' 'Stories •
New ❑. Add ❑,C Alter -0:
No. Dw.
Units
.Repair ❑ Demolition ❑ ;
Address
Tel.
City
Zip
State
Lic: #
UCENSED.CONTRACTOR'S DECLARATION .. .
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.. .
,. m .... ..
SIGNATURE DATE"-
-
OWNER -BUILDER DECLARATION `•
I hereby affirm that I ani exempt from the Contractor's License Law for the following
EStlmated Valuation
q
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 /or such permit to file a signed statement that he is licensed pursuant,do
the provisions of the Contractor's License'Law,.Chapter 9 (commencing with -Section .7000):o/.
- PERMIT
-
-. -
AMOUNT
-
' Division 3'o/ the' Business and Professions Code, or- that.'tie is exempt theiefrom, and the basis-
for the alleged exemption. Any violation of Section 7039.5'by�'any .applicant /ora permit.
•.Plan�Chk:'Dep..
"
•�
subjects the applicant to a civilpenaltyof not more than'five hundred dollars. ($500):.. . - :.•.
. O I, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk.. Bal.
COf1St.
C.•�
do the work; and Ahe 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 through. his own employees,
provided, that' such improvements are not intended or .offered: for sale. If, however, the, building
- • 12.00 '
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 /or the purpose of sale.) - ,
Plumbing
,
12.00
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- •
struct. the project. (Sec. 7044, Business and Professions Coder The Contractor's License Law
does not apply to an owner o/ property who builds or improves thereon, and who contracts for
_.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) . .. •
O I am exempt under Sec.• •B: 8 P.C. for this reason
a ! x
Grading
-
Driveway Enc.
.. .,.
Date Owner/1" frf' =
Infrastructure
WORKERS' COMPENSATION DECLARATION
hereby affirm that'l 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
❑ Copy is filed. with the city. ❑ Certified.copy is hereby furnished. ..
TOTAL
107.32
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
-
. (This section need not be completed i/ 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
employ any person in any manner so 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
.. '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 LENDING AGENCY
hereby -affirm that there is a construction lending agency for the performance of the
work for which this permit is issued: (Sec. 3097, Ci�rl code.)..
Side Street Setback from Center Line
Side Setback from Property..Line
Lender's Name
Lender's Address
FINAL DATE
a--•
"ISSUed'by:
,...
VaIidated,by:
Validation:
.
A5658
INSPECTOR
Date"' Permit
,
5 23 1,7.32 CK
This Isa building permit when properly filled out, signed and'validated, and'is subject to '
expiration if work thereunder is suspended for 180 days. . '
I certify that I have read this application and state that the above, information is correct.
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.
mentioned property for inspection purposes.
Signature of applicant fbate
Mailing Address -'
City, State, Zip
` HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
I ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP.IEQUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
I
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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
l ROUGH PLUMB. (y
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
GH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
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
q Q --
FINAL INSP.
i
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OOFING /t ! ,C�
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
NSULATIONISOUND
FINISH GRADING
��
E�FINAL INSPECTION � Z6
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS,
GARDEN WALL FINAL
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