002671 (BLCK)•:� '
4
CAV
P.O. BOX 1504 No. 002671
Building �+ 78-105 CALLE ESTADO
Address zo AV=i& valujQ LA QUINTA, CALIFORNIA 92253
Owner
KIM �.
Mailing BUILDING: TYPE -CONST. OCC,. GRP....
Address 11111-2riS A..P. Number 773-3209
City JZip Tel.
City .92234 Legal Description
Contractor Project Description
SWIM
Address
S
City . Zlp el.
Sam 3278-6691
State Lic. City
& Classif.. Lic. # 765 Sq. Ft. No. No. Dw.
Arch., Engr.,....
Size SO- UA. - ft.Stories Units
Designer New 2. Add ❑ Alter ❑• Repair ❑ . Demolition ❑
Address Tel.
City Zip State 3—foot huib bl=k ret. mil ...
Lic. # •.
LICENSED CQN- RACTOR'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. �r. t . ..
SIGNATURER ^ - - DATE _
11 OWNER -BUILDER DECLARATION Estimated Valuation q n
I hereby affirm. that I am exempt from the Contractor's' License Law for the following �I�V
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 - PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing. with Section "7000) of C
Division 3 of the Business and Professions Code, or that.he is exempt -therefrom, and the basis -r - for the alleged' exemption. Any violation of Section 7031:5 by 'any applicant for a, permit .. Plan Chk. Dep. •'-
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
❑ I, as owner of the property, or mm
y employees with wages as their sole compensation, will Plan Chk. Bal. "
do the work, and the structure is not intended or, offered for sale. (Sec. 7044, Buisness and Const. ' '1;� qyv-
Professions Code: The Contractor's License Law does not apply'to an owner of property who
builds or Improves thereon and who does such work himself or through his own .employees, Mech.
'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 . Electrical
of proving that he did not build or improve for the purpose of sale.) . .-
0 I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
struct the project. (Sec. 7044, Business and Professions Code: The -Contractor's License Law -
does not apply to an owner or property who builds or improves: thereon, and who contracts for M. 1. '
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
• ❑ I am exempt under Sec. _.-B. & P.C. for this reason" -. Grading
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I 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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished., 2,0000 AA
TOTAL 2,0. V V
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 "" Owrier
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 of this city to ' enter the above.
mentioned property for inspection purposes.
Signature of applicant n Date
Mailing Address
°
City, State, Zip r
HARD COPY
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front: Setback. from -Center Line
Rear Setback from Rear, Prop. Line
Side Street Setback from Center Line "
Side Setback from Property Line
FINAL DATE
INSPECTOR'
Issued -by:
Date ��" 0Permit
Validated by:
Validation:
A6631
11 3 20.00 CK
. CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. Y SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT. @
WALL SQ. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
/��if
I/� (/
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR. 10
SO.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
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
( � UN . REINF. �/ l_tfl
/��if
I/� (/
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR. 10
00,
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
^`
Y
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESANITIALS
GARDEN WALL FINAL