001764 (RPL)P.O. BOX 1504 N o .
Building 78-105 CALLE ESTADO
Address 44-21-1 C-vpqt M LA QUINTA, CALIFORNIA 92253
Owner
General
00.19.764
BUILDING: TYPE CONST. OCC: GRP.
Mailing .
Address 1001 B1 . Suite 2700
A.P. Number 613-421-003
Legal Description TaWt n
Project Description PWI Made aw.bt;er
City
00101plu
Zip
96813
Tel.
_
Contractor
.... . .
Address.
74--399 Wy 1U Suits 2700
LICENSED CONTRACTOR'S DECLARATION
hereby affirm that I am licensed underprov.isions.of Chapter'9 (commencing with Section
7000) of Division 3 of the Busines%ann�+d Professions Cod�e,,`a-n7d my license is in full force and
effect.
City.. _.: . _
palm�F
Zip.
9226th
Tel.'..
34.G-5511.
_
_
State Lic.
& Classif.."
City
Lic. # �3
Sq. Ft. '216' No. No. Dw.
Size Stories Units.-
Arch.; E.ngr:,
Designer
New sz Add ❑ Alter ❑ Repair ❑ '" Demolition ❑
Address
Tel.
-
-
Plan Chk. Bal.
City
Zip
State
Licr#
subject to the Workers' Compensation" provisions of the Labor Code, "you must forthwith
comply with such provisions or this permit shall be deemed revoked.
MIr11rIlUfT1 Setback Distances: -
LICENSED CONTRACTOR'S DECLARATION
hereby affirm that I am licensed underprov.isions.of Chapter'9 (commencing with Section
7000) of Division 3 of the Busines%ann�+d Professions Cod�e,,`a-n7d my license is in full force and
effect.
Rear Setback from Rearprop. Line
_
SIGNATURE -`f- - r v Y I DATE
' f OWNER -BUILDER DECLARATION'
I herebyaffirm 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, . 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 theapplicant to a civil penalty of not more than'8ve hundred'dollars ($500). . .
❑ 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'
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
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.) ---
_.❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-.
0
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
• such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. S P.C. for this reason
Estimated Valuation
D
PERMIT
-
F'a.- ' AMOUNT
.Plan Chk. Dep. -••
-
-
Plan Chk. Bal.
4✓af.
Const.
Lender's Address
Mech. - -
INSPECTOR
Electrical
Plumbing
expiration if work thereunder is suspended for 180 days.
S.M.I. ..
.50
Grading
Issued by:
Driveway Enc.
agree to comply with all city and county ordinances and slate laws relating to building
Date Owner
Infrastructure
construction, and hereby authorize representatives of this city to enter the above-
WORKERS' COMPENSATION DECLARATION
Thereby 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,..
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 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
mentioned property for inspection purposes. /'
Validated by:
Signature of applicant �� d7.._ 1/ s�Y�Jys*»9ii,*'M Date
Mailing Address
TOTAL
64 .02 ,
REMARKS
A3019
10 3U 64,2. CK
HARD COPY
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
comply with such provisions or this permit shall be deemed revoked.
MIr11rIlUfT1 Setback Distances: -
Front Setback from Center Line
Rear Setback from Rearprop. Line
. CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
I hereby affiini'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
FINAL DATE
INSPECTOR
This Is a building permit when properlyfilled out, signed and validated', and is subject to
.
expiration if work thereunder is suspended for 180 days.
10—B
• I certify: that I have read this application and state that the above information is correct.
Issued by:
Date 4 Permit
agree to comply with all city and county ordinances and slate 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 �� d7.._ 1/ s�Y�Jys*»9ii,*'M Date
Mailing Address
Validation:
City, State, Zip
A3019
10 3U 64,2. CK
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. I SQ. FT.
POR. SO. FT. ®
GAR. SQ. 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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
ISEWAGE DISPOSAL
SQ.FT.GAR ® 3/ec
HOUSE SEWER
REMARKS:
VENTILATION
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 —ANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
Cu. yd.
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 SIGNATURESINITIALS
GARDEN WALL FINAL