003630r
i
P.O. BOX 1504
Building 78-105 CALLE ESTADO
' Address 44-460 E. Sun Crest DriVe LA QUINTA, CALIFORNIA 92253
Owner
Mailing
BUILDING: TYPE CONST. OCC: GRP.-
Address.. AA—ACA n"M ^�^en#- rV. e
;.zm
A.P. Number
La Quanta Pam
City - W w
Zip _ Tel.
Ta, ouinta
92253 3 �-'2875
Legal Description
Project Description
Relocaie dYye. and wasiiE.'X:
Contractor
... _.
Address
83--210 Aneaaae 44.
City
Zip .
Tel.
Indio
92201
345-4353
_
State Lic.
City
& Classif. �
Lic. #
Sq. Ft.
Size
No. No. Dw. . .
Stories Units
Arch., Engr.; .
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑• ,
Address
Tel.
r
City
lzipState
Lic. #
LICENSED CONTRACTOR'S''bECLARATION_
I hereby affirm that I am licensed under provisions,of Chapter 9 (commencing with Section
700g) of Division 3 O the Business and P,rrofessiohss,Code; and my license is in full force and
effect'
DATE
OWNER -BUILDER DECLARATION
I ITereby'affirm that I am exempt from the Contractor's License Law for the following,
reason: (Sec. 7031.5,Business and Professions Code: Any city orcounty, which requires .a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also,
requires the applicant'for'such permit to rile a signed statement that he is licensed pursuant to
the provisions 0l the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
:'--Division 3 of the Bilsines's 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 permit
' subjects the applicant to'a civil penalty of not more than five-hundred'dollars ($500):
O 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 of 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
Estimated Valuation
A
$500.00
-
. • PERMIT
- -
- - AMOUNT
Plan Chk. Dep..
-'
-
'
Plan Chk. Bal. .
CiOrISt.'�
-
t� »'� '
Mech.. -
-
' Electrical
,
-- 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.)
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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
0 am exempt under -Sec. B. t, P.C. for this reason -
S. M.1.
_
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
4 Copy.is filed with the city. O Certified copy is hereby furnished. .
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS.
n�., �•- r ti.-. a �,• .,-� . r r„. ..
(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 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. '
.,t
Date Owner
NOTICE -TO APPLICANT., If, after making :this Certificate of Exemption you should become
' subject ro 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: -- -
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a constiuction 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
Lenders Name
Lender's Address
FINAL DATE _
”
Issued by:
Validated by:
+I�NSyIP.ECTOR
Date 4 i.i permit
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.
(.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 slate 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
1ST FL. SQ. FT. @ $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP.IEQUIP.
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.000L 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, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.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 APP.IEQUIP.
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
A
319-9
e �
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