001586 (RPL)T4t�t 4 4Q�rw
P.O. BOX 1504
Building44,-250 EaSt SUndMM�z3t �� 78-105 CALLE
Address LA QUINTA, CALIFORNIAORNIA 9 92253•
Owner
Address
City
Contractor
!t3 Ilan Qt, qs4•*, 77iniii Y
Zip ` Tel.
96823
BUILDING: "TYPECONST. OCC: GRP.
A.P. Number
054 Legal Description
Project Description, '36 $ 17 •
57-M Fal Poe
o
City _.Zip
Tel.. ....
t 'a.:ice
9
323'-73 33
State Lic.
City
& Classif. 185102
Lic. #
Sq. Ft.
No. No. Dw.
Stories Units '
•Size
Arch:' Engr: ..
.Designer
NewX Add ❑
Alter ❑ Repair ❑ Demolition ❑ ,
Address
Tel.
City
Zip
State
Lic. #
- LICENSED CONTRACTOR'S DECLARATION
hereby affirm that 1 am licensed under provisions of Chapter 9 (commehcing'with Section
7000) of Division 3 of the,Business arfd Professions Code, and my license is in full force and
effect.::..- ,• L
, , ...
... _.. .. .. ...
SIGNATURE DATE
OWNER -BUILDER DECLARATION
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, alter, improve, demolish; or repair any'structure, prior`to Its issuance alsos,-
• requires the' applicant for such permit to file a signed statement that he is licensed pursuant to
.the provisions o/ the Contractor's License Law, Chapter,9 (commencing with Section 7000) .oIt
' Division 3• of the Business and Professions Code, or. thathe is exempt. therefrom, and. the basis
for the alleged exemption. Any violation o/ Section 7031.5. by 'any applicant for a. permit.
. subjects the applicant to a civil penalty of not more than live hundred. dollars ($500). '
O 1, as owner of the, ro ert or m em to ees with wa es as_their sole con ensation, will
P P y,.. Y P Y 9 p
do the •work, and the structure is not intended or offered for sale: (Seca 7044, Buisness and
. •Professions Code: The -Contractor's 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, /or the purpose of sale:)
Estimated Valuation
�fn
-
•'PERMIT'
.. - AMOUNT
-
--Plan Chk. be
- . - -
-
Plan' Chk: Bal..
ry�t w
Const..
• +'-a
- Mech.
'Electrical
' s��yA�q
Plumbing
4..00
O 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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
. O.F am exempt under Sec. -B. 8 P.C. for this reason -
' S.M.I*.
.
..
Grading
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
Q Copy is filed with the city. ❑.Certified copy is hereby furnished.
TOTAL
226..84
..
REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE .• • ..
-
(This section need not be completed if the permit is for one hundred dollars ($100).valuation
. _orless.) - . .
• 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: If, 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.'-
'
Minimum Setback Distances: - -
-
F�ont Setback from Center.Line
Rear Setback from.Rear Prop. Line
CONSTRUCTION LENDING AGENCY
I hereliy 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 Street Setback from�Center Line
"
Side Setback from..Property Line
Lender's Name
Lender's Address
FINAL DATE'
-
Issued by:
Validated by:
INSPECTOR
-
Date ". Permit
r
This is a building permit when properly filled out, signed and validated, -and is.subject to ' .
expiration if 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 insp%ecction.purpofses.'
Signature of app lican`vi Date
Mailing Address r `R"
Validation:
A 1. 7_2 .� . _...
b Z. 5 .. 2 &,8 4 CK
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. SQ. FT. ®
CAR P. SQ. FT.
WALL SO. 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 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, 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
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
NECH.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 APP./EQUIP.
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
I NSU LATIONISO U N D
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL