13302 (PLBG)•
TA 4
P.O. BOX 1504
Building52„725 Ave. Vallejo 78-105 CALLE ESTADO
Addres•LA QUINTA, CALIFORNIA 92253
Owner Coachella Valley Land
lvldlllll
Address 78-154 Came Tampicoj. Ste.. 230
'L Qui nta, C zip 92253 Tel. 554-1155
Contractor I
Cade /Tinder
Address
Zip Tel.
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State I
Lic. #
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
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' file a signed statement that he is licensed pursuant to
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
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
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
builds .'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
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.)
❑ 1, 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
such projects with a contractor(s) ficensedjeursuant to the Contractor's License Law.)
r
❑ 1 am exempt under Sec. B. & P .for thi reason
%4e .I61I Owner
t f
WORKERS' COMPENSATION DECLARATION
I hereby affi M_that I have a certificate of consent to self -insure, or a certificate of
Worker's Cc ensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy N_oCompany
opy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I 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.
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, Civil Code.)
Lender's Name
Lender's Address
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.
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 sof this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
No. 13302
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Sewer. Connect
Project Description
Sq. Ft. No. No. Dw.
Size Stories - Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $1,306.1010
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances: 4
Front Setback,from Center Line
Rear Setback from Rear Prop. Line
Side Street Set -enter Line
e —
�Side Setback fPr10r n�
FINAL DATE 1_Li4MS
Issued by:
Validated by:
Validation:
N
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLG`MBING FEES
1ST FL. SO. FT. @ $
UNITS
SLAB GRADE
ROUGH'PLUMB.
BONDING
Y
ARD SPKLR SYSTEM
2ND FL. SQ. FT. @
FORMS
SEWER
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. @
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. @
TEMP. POLE
GROUT
DRAINAGE PIPING
CARP. SQ. FT. @
FINAL INSP.
I
WALL SQ. FT. @
WATER SYSTEM
DRINKING -FOUNTAIN.
SO, FT. @
_
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
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.
SO. FT. @ c
BATH TUB
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/ac
HOUSE SEWER
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
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND: REINF.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION ZZ
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
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CASH FEC6PTDETAIL
Received From: A
Address: _
Account No. �, f-� iota �fn a 1g 11 f� ?�"; 3 Tract s
Servioe Address '0 .1 )4i Oode
D Meter(s) -
O Service(s)
O ckflow(e)
.O Houset:ateral(a)
❑ DetectorCheck(s)
❑ Meter Surcharge
i
.O Wanitation Capacity Charge
0 TemporaryConstructionilleter
d Tan on C06Ms
O UrmollectsdA-I"tarnrs_
fl tnapection•Res- Tact -
_
❑Plan Check fees Water /Sewer -
� - • • � �
�
�
`
,
Tract -
O Bond Payment --A.D. - Bo
+1'„
'Assmt
O: Customer.Deposit`.
❑ xOther
4
TOTAL
Remarks:'
CashIfatosarl�or
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Money,
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Order--
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