09287 (BLCK)P.O. BOX 1504 No. 092.87
Building 78-105 CALLE ESTADO
Address 78-7#0 A4enidi La F0-.1 aLA QUINTA, CALIFORNIA 92253
Owner
tiY1Qr, Set BUILDING: TYPE CONST: OCC: GRP.
Mailing
Address Sam A.P. Number
City ZipTel.
1.4 01 'ifit'a 2251 Legal Description
Contractor
Project Description
Address -�Q 197' o€ .6' block -wall
74-818 Velie Dg.
City Zip, Tel
State Lic. City
& Classif.$ 3Q Lic. #� Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
" Address Tel.
City Zip State
Lic. #
LICEN� CONTRACTOR'S DECLARATION
I hereby affix,rtyyth�abl am ie used under provisions of Chapter 9 (commencing with Section
7000) of Div' it�3`of t Business and Pzotessicins Code, and my license is in full force and
effect.
ISIONATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation
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 a
Permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to lila 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 Any Section 7031.5 'any
Plan Chk. Dep.
`
alleged exemption. violation of by applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
Plan Chk. Bal.
❑ 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
Code: The Contractor's License
Const.
�i
.Professions 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,
Mach.
.
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.)
❑ 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•j,
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. • B. & 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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
72,35
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 thgwo;tOforwhich°this permit is issued, I shall not
employ any person in any manner so asPto•becomif-subject to the Workers' Compensation
Laws of California.,,°.r.+^-�•"
NOTICE TO APPLICOANT.•rI,,f//��aaher rph6 this Certificate of Exemption you should become
ZONE:
- BY:
subject to'the Workers' 6ompensa:%rUsions 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
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
- 1 hereby affirm that there is a construction lending agency for the performance of the
work for which this is issued. 3097, Civil Code.)
permit (Sec.
Side Setback. from Property Line
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
FINAL DATE
INSPECTOR
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.,
Issued by:
Date Permit
I agree to comply with all city and county ordinances and state laws relating to building
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
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST 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
WAIER 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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUG )
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEGUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLEi I (,0
``
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
f (1—'4
Li
SO.FT.GAR ® 3/.c
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE I I
PERMIT FEE
DBL
TOTAL FEES
MICRO FEEm
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 SE IC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF
GAS (ROUG )
METER LOOP
HEATING (FINAL)
OTHER APPJEGUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLEi I (,0
``
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM Ohl to
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
f (1—'4
Li
3/11 Gtl
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL