001761 (RPL)P.O. BOX 1504 NQ., 001781 .
Building 78-105 CALLE ESTADO
Address 44—M E. %dE M.. Vj% LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. OCC: GRP....
Address 1001 Bi D St. Slaite 2M A.P. Number 613-421-003
City Zip Tel.
WMAInIn 90 Legal Description Uwt 19903
ContractorProject Description PDnl ! It'd_ C`EWr2r
Address.. ill
y -
T4 399 �iT ill � LE
City. Zip.. -..... Tela _ .... -
92260 3455511. -
State Lic. City
& Classif. - 4�4� Lic. # Sq.-Ft.;� No. No. Dw.
237
Arch., Engr., _.
Size Stories - - Units
' Designer New Q Add O Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic: # .
LICENSED CONTRACTOR'S•DECLARATION. v
ar I hereby affirm that.I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Divlsion 3 of the Busines
sand Professions C�oclee; and my license is in full force and '
effect.
SIGNATURE ti .i _/: DATE '
{f OWNER -BUILDER DECLARATION '
I hereby affirm that I am exempt from the Contractor's License Law for the.following Estimated Valuation
reason; ,(Sec.,_ 7031.5,Business and Pro/essions ,Code; An cit or _count q I�E�•C'v
y. , y y .which re uires a F
permit- to construct,, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant./on such permit to file a signed statement, that he is licensed pursuant to •. ..PERMIT - AMOUNT' +
the provisions oI the Contractor's License Law, Chapter,9 (commencing with Section 7000). of - -
Division 3 of the Business and Professions Code, or that. heis exempt therefrom, and -the basisfor, 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). a
t, 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.COf1St.. q�
Professions Code: The Contractor's License Law does not apply to an. owner of property: who 39.50
builds - or improves thereon and who does such work •himself - or through - his own employees,
provided that such•improvemenls 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
of proving that he did riot, build or improve for the purpose of sale.),
O 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
❑.I am exempt under Sec.., B. 8 P.C.'(or 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. .0 Certified,copy is hereby.furnished.
TOTAL 64.02
CERTIFICATE OF EXEMPTION FROM 'REMARKS..
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation -
or less.)
., .. _
1 certify that in the performance of lhp work for which this permit is issued, I shall not 'f
employ any person in any manner so as to become subject to the Workers' Compensation' „ -
Laws of California.
Date Owner' '
NOTICE TO APPLICANT: I/, alter making this Certificate of Exemption you should become ,ZONE: BY: "
subject to'fhe 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 r Side Street Setback from Center Line
I hereby affirm that'tfiere 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 Linea
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 if work thereunder is suspended for 180 days. t ys_�
I certify that I have read this application and state that the above information is correct. Issued by: Date 10— Permit
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 i✓%t . r �/''✓ 9ilT.+ i1 i�+J/Lr. " t Date
Mailing Address ~�^ x t. Validation:
M
City, State, Zip
' A 3 0 2 2 1U.. 30 64,62 R_
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. p $
2ND FL. SQ. FT.
FOR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SO. 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 EH
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.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIIYITIALS,
GARDEN WALL FINAL