003546 (SPIN)P.O. BOX 1504 No. 003546
Building 78-105 CALLE ESTADO
Address 78~040 La Fonda., . LA QUINTA, CALIFORNIA 92253
Owner
Troy & Donna ftee
Mailing BUILDING: TYPE CONST. OCC' GRP.
Address Save.
" " A.P. Number
City Zip Tel.
Legal Description
Contractor Special ibnppation,
Project Description
Address. ..... .
City Zip Tel..
State Lic. City
& Classif.•. Lic. # Sq: Ft. No. No. Dw.
Arch:Size Stories Units
, Engr., . ... __ ...- ..
Designer New ❑ Add ❑ Alter ❑ Repair ❑ • ' Demolition ❑
Address Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S, DECLARATION,
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section '
{
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
_SIGNATURE DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law dor the following
reason: (Sec. 7031.5,8usiness and Professions Code: Any. city or county which requires a
ski
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 Section 7031.5 by 'any for
Plan Chk. Dep. -
- -
.• violation o/ applicant a permit
subjects the applicant to a'civil penalty of not more than five 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
Const.
..
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,
-
Mech.
provided that' such Improvements, are not intended or offered /or sale. If, however, the building '
or improvement is sold within one year of completion, -the owner -builder will have the burden
Electrical
of proving that he did not build or improve for the purpose of sale.) -
.
❑ 1, 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. 1.
-
such projects with -a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Seo. B. t. P.C. for this reason
Driveway Enc.
DateOwner
InfrBstructure
Snecia,l Tnsoe yt'ion y fail
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
[ICopy is filed with the city. ❑ Certified copy is hereby furnished.
_
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
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.tE�,L�t
r 7j
Date Owner `
9fi� t411 s'j(}
NOTICE TO APPLICANT. If, after making this Certificate o/ Exemption you should become
ZONE:
BY: '
subject to the Workers' Compensation provisions of" the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. -
Minimum Setback Distances: -
Front Setback from Center Line
Rear Setback.from Rear Prop. Line
colusTRucnoN LENDING AGENCY
Side Street Setback from Center Line '
I hereby affirm that there is a construction lending agency for the performance of they
work for which this permit is issued. (Sec. 4097, 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 certify that 1 have read this that information
y
i
application and state the above is correct.
' •I agree to'comply with all city and county ordinances and state laws relating to building
Issued by:,,
Date ermit
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
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. 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
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 APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FE7
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 APPJEOUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
- FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL