003410 (BLCK)' f
QUW4 Aiyl -
414"
P.O. BOX 1504 No.
78-105 CALLE ESTADO 003410
00 VALTX- 0 LA QUINTA, CALIFORNIA 92253.
='S=CTiON
Zip I. ' Tel.
92253 564-2228
BUILDING: 'TYPE CONST. OCC: GRP.
A.P. Number 774-282-009-010
Legal Description
Project Description 3' iftCH RT 200° Oat. ALJ� '
Building
City
Address
5$-660
Owner
State Lic.
RICK JOHN"
Mailing
Address
P _�
City
No. No. Dw.
.. LA.� .. .
Contractor
Size
Stories Units
- ch.;Engr.,..
...;. _.. ..
.Ar
Designer
Address. .
Alter ❑. Repair ❑ Demolition ❑.
' f
QUW4 Aiyl -
414"
P.O. BOX 1504 No.
78-105 CALLE ESTADO 003410
00 VALTX- 0 LA QUINTA, CALIFORNIA 92253.
='S=CTiON
Zip I. ' Tel.
92253 564-2228
BUILDING: 'TYPE CONST. OCC: GRP.
A.P. Number 774-282-009-010
Legal Description
Project Description 3' iftCH RT 200° Oat. ALJ� '
City
Zip .
Tell'
State Lic.
City
& Classif. 3197-169 F
Lic. # 202
Sq. Ft.
No. No. Dw.
Size
Stories Units
- ch.;Engr.,..
...;. _.. ..
.Ar
Designer
New ❑ Add ❑
Alter ❑. Repair ❑ Demolition ❑.
Address
Tel.
...
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
v
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of DivisioW3 of the Business and Professions Code, and my license is in full force and
effecI/z�'.e's� ( 17i%i" .mac.. 7_,y
• 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, atter, 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; Chapter9 (commencing with Section 7000) of
EStlmated Valuation
@ �f
3*0 00
-
PERMIT
,
~AMOUNT
' Division 3 of the Business -and Professions Code, or - that. he. is -exempt therelrom,'and-the,basis
for the alleged exemption. Any 'violation �ol Section 7031.5' by 'any. applicant for apermit'
-
Plan Chk. Dep.'
subjects the 'applicant to'a-civil penally of not more than five hundred dollars ($500). - -^
❑ I, as -owner of the property, or my employees with wages as their sole compensation; will -
w
Plan ,Chk. Bal.
- � -
�@+�s
26*7�4
Const.
-
t' Cit
�3�+1.50. '
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, nol'apply to an owner of'property who
Mech.
builds or improverihere'oh,and- who does such work himself or through his own employees,
. provided that',such •improJements are not intended or offered. for sale. If, however, the building. '
Electrical
' '
or improvement is sold' withlh 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.)
Plumbing '
0 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
S. M. 1.
_.
- .50-
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑.I.am exempt under Sec. B. 8 P.C. for this reason
Grading
Driveway Enc.
Date owner
Infrastructure
I
WORKERS' COMPENSATION DECLARATION
' I hereby' affirm that I have'a certificate of consent to self -insure, or a'cbrtificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No: Company
. .q Copy is filed with the city. . ❑ Certified copy is hereby furnished. ..
TOTAL
. .
P. s✓
REMARKS -
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.) - .. ..
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.
r «ti -.• W,- fir. d, s
tfr '�.A I i O f F..,,, 1 6:i . Y 2
' "D'ate ' Owrier '
NOTICE TO APPLICANT. It, 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. -
ZONE: - BY: '
_
•Minimurn Setback Distances:
Front, Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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.).
$Ida Setback from Property Line
Lender's Name
l
fender's Address
FINAL DATE
-
Issued by:
j,.•
Validated by:
INSPECTOR
Date 4124187 -Permit
This is'a'building permit when properly filled out, signed and validated,'and is subject to
expiration it 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 Date
Mailing Address
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES`
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CARP. SQ. FT.
WALL SQ. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 C
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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 APPJEOUIP.
7(jLREINF. STEEL D — ? ��
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
I
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL