002666 (BLCK)614
�.
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address '52—MAmAda, V4Uejo LA QUINTA, CALIFORNIA 92253
No. Q�
'Maw
BUILDING: TYPE CONST.
OCC: GRP.
Mailing
Address.4_25� _5 I1
A.P. Number 773-324-011
Legal Description
Project Description.
lot 16
City Zip
Tel.
Contractor W
Address ..
Sam
City-
Zip
Tela
State Lic.
City
& Classif. 1557580
Lic. # r65
Sq. Ft. 1?
Size
"No. No. Dw.
gtories Units
Arch., Engr.,
Designer
New p; Add ❑
Alter ❑ Repair ❑ Demolition -0
Address
Tel.
City
Zip
State
3—foot high
bLoCk retaining wall
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 f -r 'In DATE
OWNER-BUILDERtDECLARATION S.
t>�-m� .. •.
I hereby affirm that Fam exempt,fromxthe Contractor's License Law for the following
reason: (Sec. 703.1.'5,Business and Professions„ Code. Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, pdor.to its issuance also
the applicant for such permit to rile 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 rive hundred dollars ($500).
O 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
Estimated Valuation
e 4 . rl�itt •A�
1eT Z.S v 7 J 0!
PERMIT
,
tir -AMOUNT
Plan CihR. Dep.
-
Plan Bal.
Chk.
- -'
20,...,3 5
Const.
31.00
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
or improvement is sold within one year of completion, the owner -builder 'will have the burden
- of proving that he.. did not build or• reprove for the purpose of sale.) -
Electrical
'
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
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 •'
-
S. M. j,
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
0 Copy is filed with the city., ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION. INSURANCE.
REMARKS
'
(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 Workeis" 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
1 hereby affirm that there is'a construction lending agency for the performanceof 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
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 It t1
Validation:
A 6 6 0 7
T
1 0 3 0 5 1 6 5 U
City, State, Zip_ Z.) - _. !,P'
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL.SQ. FT.
YARD SPKLR SYSTEM y
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
.?> //
(/
DRINKING FOUNTAIN
SQ. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ plus x$
LAUNDRYTRAY
AIR HANDLING UNIT CFM
OF
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
FIRE ZONE ROOFING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SPARK ARRESTOR
SQ.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 OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUN EINF. `�
td
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(/
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE/--VI—NAL
INSP.
BOND BEAM /�
WATER SYSTEM
FINAL INSP.
GRADING
cu. yd.
$ plus x$
=$
MBER GR.
OF
F MING 12 1 XG
FINAL INSP.
V eR00FING Y1 f �d
iC
1 "
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