003206 (BLCK)0
Building
Address Sok
Owner
Mailing '
Address 731,
City
Contractor
P.O. BOX 1504 r No.
78-105 CALLE ESTADO 00320
AVOAMA oa f LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
William Rd, A:P. Number 774-302-006-w18
Zip Tel. -
92212- 322-1020. Legal Description .
Project Description, 150' netf4V1V)tQ WRIT '�# Af1h
I !"_atenntklle+ent?em�
733 William Road _
'City
Zip
Tel... »
PAL" Se"rimps
922A2
322-1020
State Lic.
City
& Classif. 387934
Lic. # 73
Sq. Ft. -
No. No. Dw.
•
Size
Stories Units
.Arch.; Erigr.,
Designer
New ❑ Add ❑
Alter ❑ .. . 'Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. # _.
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter g (commencing. with Section'
7000) of Division 3 of the Business and Professions'Code; and my license is.in full force and
effect. �t +' , .
_
SIGNATURE' " _ _"." 6-`,..
-,i," - - DATE
...
... _
~ OWNER BUILDER DECLARATION "
'I hereby affirm that 1 am exempt from the Contractor's License'Law'for the following
Estimated Valuation
reason: (Sec. 7031.5,Business and Professions Code: Any city or county. which requires. a+.
• Professions,-
permit to construct, after, iinprove, demolish, or structure, prior to its issuance 'also
requires the applicant for such.permit to file a signed statement that he is licensed pursuant lo�
-.PERMIT '
- -
- -• AMOUNT
the provisions of the Contractor's License Law, Chapter 9.(commencing with Section 7000) of
- e�
"Division 3 of'fhe'Business andProfessions Code, or that. he 'is. exempt therefrom, and the basis..
for the Any Section 7031.5. by 'any for •
•
Plan Chk. -Dep.-
. .
-
alleged exemption. violation or applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500)...
Plan Chk. Bal..
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
Const.
Professions Code: The Contractor's License Law does not apply to an owner of property who
w s -
builds or improves thereon and who does such work himself or through his own employees,
Mach.
-
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
_ or proving that he did not build or improve for the purpose or sale.) '
❑ 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 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
-
O I am. exempt under Sec.- B. 8 P.C. for this reason
Driveway Enc.
Date.L.Owner
Infrastructure
"'" --'0' WORKERS' COMPENSATION DECLARATION
" r 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
L -Copy is filed with the city. ❑ Certified copy is hereby furnished.
_
TOTAL;.°s}
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
W„ 1 I
�E 44 N �' *r r1 j « L, f✓ 7! r, -.z r+
.
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: 8, after making this. Certificate of - Exemption you should become
ZONE:
BY: '
- `subject to the Workers' Compensation provisions of the Labor Code, you'rhust forthwith
comply with such provisions or this permit shall be deemed revoked. •-
Minimum Setback Distances: .
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.) • -
Side Setback from Property Line .
Lender's Name
Lender's Address
' This is a building permit when properly filled out, signed and validated, and is subject to
FINAL DATE
INSPECTOR
expiration it work thereunder is suspended for 180 days:
I certify that I have
7/ /A7 -
read this application and state that the above information is correct. -
' I -to
Issued by: -
Date Permit .. -
agree 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
HARD COPY
T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. p
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
9
DRINKING FOUNTAIN
SO 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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
�G
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ plus x$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1114 c
SEWAGE DISPOSAL
FIREPLACE
SQ.FT.GAR ® 3/4c
HOUSE SEWER
SPARK ARRESTOR
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
F42-4
J
ND. REINF. r
9
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
OUT
WATER HEATER
SERVICE
FINAL INSP.
ND BEAM
�G
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL