002400 (BLCK)r
P.O. BOX 1504
78-105 CALLE
Addrress 554 1" ftMai& Wlej0 LA QUINTA, CAL FORNpIA 92253
Owner
iffle
Mailing
Address
City Zip Tel.
Contractor ,,
ii ... .
Address .. .
P. 40- Pm. 835
City Zip Tela
P 1 94261 50-4014
aL
State Lic. City
& Classif... f _i ..i Lic. #
Arch., Engr.,.. .
Designer -
No. 002440
BUILDING: TYPE CONST. OCC: GRP:
A. P.. Number 774—,213 — 026-
L . egal
26`Legal Description lot 20 �
Project Description
Hoot h:k& wood fimm.
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ . Repair ❑ Demolition ❑
Address
Tel.
Minimum Setback Distances:
Front Setback from Center Line
City ft
Zip
State
Lic. # ..
_
Side Setback from.Property Line
LICENSED,CONTRACTOR'.S'DECLARATION
I hereby affirm that I am licensed onder,p vision's of Chapter9 (commencing with Section
• 7000) of Division'3Aof the,Busiinnress and Professions Code, and my license is in full force and
effect. V- !,� ,fit ` �/ 7 f,ojI
FINAL DATE
INSPECTOR
Issued by:
Date -6 10" $fiPermit
SIGNATURE** 4• - +t' �. � �--� —DATE
OWNER -BUILDER DECLA TION
;!:= r--
I hereby affirm that I am exempt from the Coniractors 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).
p- 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 oroffered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property ,who
.Professions
or improves thereon and who does such work himself or through -his own employees,
prov_ided,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.). - , - , ..
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
strucl 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.)
❑.I am exempt under Sec. B. & P.C. for this reason
Estimated Valuation A, 4� +�y
� 1ijr23240
Validation:
PERMIT -o -
AMOUNT
plan Chk. De p
6 .1 0 X 89,53 CK
Plan Chk• Bal.
�tl
64.22
Const.
92.50
Mech.
,
..
Electrical
Gtlw7t%'
Plumbing - -
12.0
S.M.1.
-
Grading
Driveway Eno.
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.. O 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 Owher
TOTAL
329.53
REMARKS
-
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you shouldbecome
'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.' r s (J
Signature of applicant �- /.��' �� urpos/es
. i r. -Date.'" f4�••s" -.
Mailing Address
City, -State, Zip
HARD COPY
_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 -6 10" $fiPermit
Validated by:
Validation:
A 5 7 4 7
6 .1 0 X 89,53 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES -
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SD. FT.
SQ 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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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/a c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR C 3/acHOUSE
SEWER
FRAMING
1 jl FINAL INSP. L, f
I
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
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE-
FINAL INSP.Z j /
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.�// /
� 1
FRAMING
1 jl FINAL INSP. L, f
I
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION e
CERT. OCC.
FENCE FINAL
inarc�.1 vn a alunia i vnc�mll iNw,
GARDEN WALL FINAL