07677 (SATT)0 0 , oul -1 - - I
44
P.O. BOX 1504 N u . 07 677
Building78-105 CALLE ESTADO
Address 55 458 Laurel Vallav LA QUINTA CALIFORNIA 92253
Owner
mauing
Address 42-600 Cook 5
City I Zjp
Contractor
Address
City IZip
1 -
Tel.
State Lic. I City
r & Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
^ City I Zip ( State
R Lic. #
/ LICENSED CONTRACTOR'S DECLARATION
o I herebyiaffirm that I am licensed under,, rovisions of Chapter 9 (commencing with Section
i 7000) o(:Division 3 o/fthe Business and:Professlons Code, and my license is in full force and
l et_ffect.4 L lf. --- - �/_. 4)A
SIGNATURE.;'— `X' —IT r P iDATE
li, i OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: AAny 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
the provisions of 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
' 'subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
' Q 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 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 for the purpose of sale.)
❑ 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.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date O„vner
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. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(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.
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.
CONSTRUCTION LENDING AGENCY
I 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.)
Lender's Name
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 ordinances and state laws relating to building
M construction, and hereby authorize representatives of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
o2 rV1
UILDING: TYPE CONST: OCC. GRP.
.P. Number PGR MP_S't
egal Description Tract 26500-1
roject Description Phgmx 2N Plita Id
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $95,051
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. 512.8.1
Const. 626,00
Mech. 60,00
Electrical
Plumbing 12n. 50
S.M.I.
-79
Grading
Driveway Enc.
Infrastructure 2 16I.I5�
Less 6 SUM. ba
TOTAL .448 (./'. ._. J 1
REMARKS t305?. i+1X sT?S^{�-9��
ILd Lti.�f x bi3 Mlt. i f -,-#v If a A -v
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date 4/2519E?Perm
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® r $
2ND FL. Sp. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. I Sp. FT.
WALL $Q. FT. ®
SO 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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DIS H)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL'
FURNACE UNIT WALL . FLOOR SUSPENDED
`Y��AS (ROUGH) Q� �)
✓ v
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
SO. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 Va c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
'' //,,
Q(�4RAMING — %
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE LPL.CCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
PAWUND PLUMBING 5��C1
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
MSEWER OR SEPTIC
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. ��\
V
`Y��AS (ROUGH) Q� �)
✓ v
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
I WATER SYSTEM
GRADING
cu. yd.
$ plus
LUMBER GR.
INAL INS�Q
'' //,,
Q(�4RAMING — %
FINAL INSP.
ROOFING 0 67 V .
Q,1
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING 0
MESH
INSULATION/SOUND _Q'J
FINISH GRADING
FINAL INSPECTION,
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL