04333 (BLCK)044, e
P.O. BOX 1504 -
Building 0 Coon—t78-105 CALLE ESTADO
Address = LA QUINTA; CALIFORNIA 92253
J
Owner. • .Tob Linda Stanf d
BUILDING: TYPE CONST. OCC. GRP.
Mailing
�
Address
A.P. Number La �'!�5�.=�tSAPalms ti
City Zip Tel. .
La
f, Yat ita 9 5 � ,,. Legal Description
• Contractor Project Description "O' ,aarden will 4 ° high
• c3c�T> � � i'>9ia ii. �. C�� x
Address
City_ Zip Tel.
State Lic. - City
& Classif. Lic. # Sq. Ft. No. No. Dwr
Size Stories Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ .Demolition ❑
Address Tel.
• S
City Zip State
'.`.?�a cri':• Lic. #
LICENSED CONTRACTOR'S DECLARATION
I'herpby" prm:tliaCl am licensed under provisions of Chapter 9 (commencing with Section
7000)'of DIv'islon'3'of the Business and Professions Code, and my license is in full force and
SIGNATURE' - DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following 011,290-
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 also - -
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT AMOUNT'
the provisions o! 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 Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than live hundred dollars ($500)..
❑ I, 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
' Professions Code: The Contractor's License Law does not apply to an owner of property who Const. .50
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 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.) Electrical
❑ 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.) - e
r- Grading
O 1 am exempt under Sec. B. & P.C. for this reason DfIV@Way Eric.
Date �? 'b t(-� Owner �•" }�; F ' 't- 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. O Certified copy is hereby furnished. a
TOTAL
CERTIFICATE OF EXEMPTION FROM- REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation - j);;e;?�,;�•� ,�{'�.t.-g;,ff�,f},.,,jOr"y;�,fj.+•�,„;#:�Y,;,.,,:,i�':•--
4 or less.) • ` - d. :v.. _ _ .G4F1aru E' 4'
I certify that in the performance of thgwork 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 youshould become ZONE: - BY: -
subject to the Workers' Compensation provisions of the Labor Code, you must forthwithMinimum 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,. Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the J
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 properly filled out, signed and validated; and is subject to
expiration If work thereunder is suspended for 180 days.. ,�� •• . - ' • . •• i+' "' l `r f rJ6a .
I certify that have read this application and state that the above information is correct. Issued by. Date Permit
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 inspection purposes. Validated by:
Signature of applicant Date -
Mailing Address Validation:
City, State,.Zip.
h - ' WHITE_ FINANCE, PINK - APPLICANT GREEN m.BLIILDING, GOLDENROD - ASSESSOR'S.OFFICE HARD COPY;- FILE ' %
't,�_,>`.a'i�``}�. ''rTJa•: ,1.it �F:.s -..^ -�'_-, l.r....A. ��: ..�_. -.:'i k5 x_t :,._ �y._ �.:4.^;.. .... _-.'t'+fS. ut!<,. .r..".,.�-'�.. �1+L�^'�'#�;: ?:'s r,,.�..:,.i..i. «:'a �: _�w;i' .: R.'s....__.*..3i ��y. -c. L'A3:- A.��%... ,.ti."i.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEEW�
$
UNITS
COLL. AREA
SLAB GRADE
IST FL SO FT ip
ROUGH PLUMB
YARD SPKLR SYSTEM
HEATING (ROUGH)
2ND FL SO FT. 6
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING -
MOBILEHOME SVC.
BAR SINK
FOUND. REINF. /
-?//?/go
POR SO FTat
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
OUTLET
ROOF DRAINS
GAS (FINAL)
GAR SO. FT. 0POWER
GROUT.
WATER HEATER
DRAINAGE PIPING
FINAL INSP. .�
CARP. SO FT. 0
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
DRINKING FOUNTAIN
LUMBER GR.
WALL SO. FT. @
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
URINAL
SO. FT. B
REMARKS:
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FIRE ZONE ROOFING
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
LATHING
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
INSULATIONISOUND
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
FINAL INSPECTION
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
GARDEN WALL FINAL
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID a 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR (a 3/.c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
M'=CH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE
PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 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. /
-?//?/go
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
pC
REINF. STEEL
0 L
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS ,
GARDEN WALL FINAL
7d