10466 (PLBG)4
P.O. BOX 1504 f .o. 1,0466
Building78-105 CALLE ESTADO
Addres53-435 Vallejo LA QUINTA, CALIFORNIA 92253 � �(
Owner
Rebecca Wilson
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address same A.P. Number 774-082-021
City Zip Tel.
La Quinta 92253 Legal Description
Contractor Project Description 5't'wer Book up
Econo Serer Service
Address
68415 Perez Road
City Zip Tel.:
Cat. Citi 92234 346-2793
State Lic. City
& Classif. 4849€1 Lic. # 342 Sq. Ft. No. No. Dw.
Arch:, Engr., Size Stories Units
Designer New ❑ Add ❑ Alter O Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under proviplbns of Chapter 9 (commencing with Section
7000) of Division 3 of the Bussinneess and Professions Code, and my license is in full fort and
effect. r'�. /' % . C.�2-
SIGNATURE / """ i 1 i r DATE
✓
OWNER-BUILDER DECLARATION Estimated Valuation 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 1/2.50,
permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance also AMOUNT
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT
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 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. Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const..
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,
provided that such Improvements are not intended or offered for sale. If, however, the building Mech.
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.)
❑ I, as' owner of the property, am exclusively contracting with licensed contractors-to con- 'Plumbing J0. UU
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 to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. tx P.C. for this reason '
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.
TOTAL .JU • U
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation .rhA"`;4A7 _i0. 7045?. 017-21--92 _Q
or less.) i«.' t t�.Yf� ) t Ca i WL k QV . arSi
I certify that in the performance of the 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 ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback.from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) r Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
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. Issued by: Date Permit
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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
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
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ic
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
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
JA2EWER
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL