003585 (BLCK)UW
P.O. BOX 1504 No. X0'3585
Building 78-105 CALLE ESTADO
'Address 44-460 E. St ndo .-Crest 1),t,A QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. OCC: GRP,
Mailing
Address sar A:P. Number 613
City Zip JTel.
La Qui
nta - 92253 _ Legal Description
Contractor Project Description
DWC Aa8ociates ,
Address. r h° ✓ :' „s may' ,:.
& Classif.
-Arch., Engr:,
Designer.
Address
City
I hereby affirm f of I
Zip Tel.—
City
Lic. #
Zip
State
Lic. #
DECLARATION
Df Chapter 9 (commencing with Section, .
.ode, and my license is'in full forde.and .
Sq. Ft.- No. No. Dw.
Size Stories Units
New ❑' ..Add ❑ Alter•❑: Repair ❑ Demolition -0
n✓± ..f .: i':. ! .a y qtr"
.,. ..
.. y-. .. .. .. .. ..
SIGNATURE \. .p .�. �, ! r .. f cDATE .
" OWNER -BUILDER DECLARATION
• I hereby affirm that 1 am exempt from the Contractor's License Law for the followingV�67.�yV.
EStlmSted Valuation
CC pathe iio�ta
. reason: (Sec. 7031,5;Business and Professions Code: Any city or county which requires 'a,
permit to construct, alter, improve, demolish, or repair repair any prior to. its issuance also
- requires. the applicant for such permit to file a signed statement. that he is. licensed pursuant to
PERMIT
.,
nn•
`• ' - AMOUNT
i
. the provisions of. the Contractor's License Law, Chapter 9: (commencing. with. Section 7000) of
Divisi6b'3of the Business. aridProfessions 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 five hundred'dollars (3500).
O 1, as owner of the property; or my employees with wages as their sole compensation, will
PIan,Chk. Bal.
COW.'
, ,° .00
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,:
.-Mach: -.
.
-
., "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
Electrical
.,
or improvement is sold within one year or completion, the. owner -builder will -have the burden
• .of proving that he did not build or improve for the purpose of sale.) .. ..
•Plumbing
❑ 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
S.M.L. - -
_ - - • '
such projects with -a contractor(s) licensed pursuant to the Contractor's License Law.).
❑ 1 am exempt under.Sec. B. & P.C. for this reason
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
O Copy is filed with the city.. O. Certified copy is hereby furnished....'
TOTAL
_
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS. • .
_
(This section need not be completed if the permit is for -one'hundred dollars (3100) valuation
or less.).
- I certify that•in the performance of tha 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.
yR
titLr i1Qi• �� Jw
.)t',',-.,jrk-•�
' 'Date__L� Owner'
NOTICE TO APPLICANT. If, after making this Certificate- of.. Exemption you should become
subject to' the Workers' Compensatlon provisions of the Labor Code,. you must forthwith
comply with such provisions or this permit shall be deemed revoked.' • -
ZONE: BY: '
Minimum Setback Distances: '
• • - - -
Front Setback from Center Line
CONSTRUCTION LENDING AGENCY
I hereby affirm that theta is a construction lending'agency for the performance of the
work for which this permit is.issued. (Sec. 3097, Civil code.)'
Rear Setback from. Rear Prop.. Line
Side'Street Setback from Centerline
Side Setback, from, Property Line
Lender's Name
FINAL DATE
Issued by:
Validated"by:
INSPECTOR
. tt / 21 / 8
"'I/21/8
Date' i6 1 Permit
J.
Lender's Address
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 oidinances and state laws relating to building :
construction,. and hereby authorize representatives -of-this city to- enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address .
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. p $
2ND FL. 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.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
V C
��
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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
ROCKSTORAGE
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
V C
��
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