003552 (PAT)TAt�t
P.O. BOX 1504
Building- 78-105 CALLE ESTADO
Address 44-241 W. Sundown-w.reS$ LA QUINTA, CALIFORNIA 92253
Owner . .
BUILDING: TYPE CONST. `OCC:.GRP.
Mailing.
Address 23-27 Robert Road' La�in�a. �'a
_ A.P. Number
City Zip Tel.
Torrance ... _ 905.05 21.1-7316-7067 Legal Description
*`,Contractor . PFi io Cov6r
.
Project Description
ow et/B'Uildi�r
Address
City.
Zip
Tela
State Lic.
City
& Classif.
Lic..#
Sq. Ft. 216.No.
No. Dw.
Size -
Stories - s Units
- Arch.; Engr.,-_...... _ .. _ , .. _
Designer
New ❑• • Add ❑
Alter El - Repair ❑ .-Demolition ❑
Address
Tel.
City
State
]Zip
Lic:-#
•, LICENSED CONTRACTOR'S DECLARATION
Thereby affirm.that I em licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions:Code,'and my license is in full force and
m -'
-
effect. -..
SIGNATURE DATE
' OWNER -BUILDER DECLARATION '
Estimated Valuation
I hereby affirm that 1 am exempt from the Contractor's License Law for -the following:
• reason: (Sec_. 7031. S, Business and Professions" Code: Any; city .or county which requires a
'to
- GII V • V '
peimit 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 do--
PERMIT
•- AMOUNT
- the provisions of the Contractor's License' Law, Chapter .9 (commencing with Section 7000) -of ;
- -
- Division 3' of the-&isiness and Pro/essions Code, or that. heJs exempt therefrom, and. the .basis
for the Any Section 7031.5 for
-
Plan Chk.. Dep.. -
- -
alleged .exemption. violation of .by any applicant a permit
subjects the applicant to a civil penally of not more than We hundred dollars ($500):'
I,
Plan Chk.
O, 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
-Bal..
'Professions Code: The Contractor's License Law does not apply to. an owner o/ property who
_COf1SfI'
�3�r-
builds or improves thereon and who does such work. himself or through his own employees,
Mech. -
-
• provided that such improvements are.not intended or offered /or .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 not build or improve for thepurpose o/ sale.) -
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing -
- struct the project. (Sec. 7044, Business and Professiorfs;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 2= 12 Olt Owner -�" r/
Infrastructure
WORKERS' COMPENSATION DECLARATION
I'hereby affirm* that Fhave 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.. - ..
TOTAL
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is'forone hundred 'dollars ($100) valuation-
i - -
. or less.) . .. ... _ .. ...
I certify that in the performance of the work for which this permit is issued, I shall "not
rg
employ any person in any mannerso as to become subject to the Workers"Compensation
Laws of California.
Date Owner _.
NOTICE TO APPLICANT: 1f, after making this Certificate, of Exemption you shouldbecome: �
' -ZONE: � � '�
BY: -
"subject to the 'Workers' Compensation provisiorns of the .Labor Code,' you must forthwith
comply with such provisions or this permit shall be deemed revoked..
.Minimufn 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.)
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 if work thereunder is suspended for 180 days. - _
I certify that I have read this application and statethat'the above information is correct: -'".
I
ISSUed by:
Date 1 131 1�f?" mit
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 Date
Mailing Address
Validatiorc
City, State, Zip
HARD COPY
-
T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ, FT, ®
POWER OUTLET
ROOF DRAINS
CAR P. Q. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEQUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
LATHING
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.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
U
000
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL