002997 (CRES)i
l u�G`%rGv
P.O. BOX 1504
Buildings 78-105 CALLE ESTADO
Address 78-730 FMOM %t Fla LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address sam as abcom
City Zip Tel.
xa Qiix*a 922513
Contractor
.Address..
78-725 Calle La. Fonda
City - - Zip Tel....
%t Quir*a 92253 564 -SWI
State Lic. City
& Classif.. $ 506812 Lic. # c
Arch., Engr:,
Designer
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. tt
SIGNATURE- t'_,-.+�' u's•-+'+�°. �+s�"""' ' } DATE
- ' ' 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: Any city or county which_requires a
No. 002997
BUILDING: TYPE CONST. OCC.'GRP.
A.P. Number
Legal Description
Project Description
Sq. Ft. _�� No. No. Dw.
Size - Stories -Units -
New pg Add ❑ Alter ❑
Estimated Valuation
$4.332.00
Repair ❑ Demolition ❑
permit lo.consfruct, alter, Improve, demolish, or repair any -structure, prior to its issuancealso.
I
- f. -
requires the applicant for such permit to file a. signed statement that he is licensed pursuant to
PERMIT,
AMOUNT
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
PlanChk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). -
_ Plan Chk. Bal..
1r� Cy
32.8ry
❑ 1, 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
Const.
s
� {�
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 for 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 or sale.) -
O 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, �
projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
.50such
Grading
.O I am exempt under Sec. B. 8 P.C. for this reason
..
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
831*82
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION .1 NSU RANCE
(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, 1 shall not
'
employ any Person in any manner so as to become subject'to the Workers''Compensation
Laws of California. !�
Date 7 Owner
NOTICE TO APPLICANT: If, after' making this Certificate of Exemption you should becomeZONE:
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
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 it 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
construction, and hereby authorize representatives sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant -Date-
Mailing
ateMailing Address
City, State, Zip
HARD COPY
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: - Date 3119/07 Permit
Validated by:
Validation:
A7570 3 20 83.82 It.
�S CONSTRUCTION ESTIMATE
NO. ELECTRICACFEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
FOR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. I 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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
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.
VSQ. FT. ® c
BATH TUB
BOND BEAM.
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.F.EE
CONST. FEE JELECT.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.
J
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
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH •
INSULATION/SOUND
FINISH GRADING.
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL