002663 (BLCK)y .
P.O. BOX 1504
No. 00263
Building 78-105 CALLE ESTADO
Address 46-145.aefferSm Strwt LA QUINTA, CALIFORNIA 92253
Owner
PidmeU
- BUILDING: TYPE CONST. OCC: GRP.-
City
RP.
Address
City
Estimated Valuation
ZipTel.
r:.'�tA .
92253 .
Rear Setback from Rear Prop. Line
• Contractor
• requires the applicant for such permit to file a signed statement that -he is licensed pursuant to
PERMIT
.. " .
ie :t tk truc'��.i= C 'any
Address .
•
for the alleged exemption. Any violation of Section' 7031..5 by:'any applicant for a permit
Plan-Chk. Dep. -
' subjects theapplicant to a civil penalty of not more than live hundred dollars ($500). ' '
Plan Chk. Bal.
City
Zip
Tel.'
Indio
92.202
' Mech. -
State Lic.
City
& Classif.
.�
Lic. # 2
-Arch:, Engr:,
Plumbing
struct the -project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
' Designer
. does not apply. to an owner of property who builds or improves thereon, and who contracts for
- S.M.I'.
Address
Tel.
CityZip State
. Lic. ft•
LICENSED CONTRACTOR'S DECLARATION _
I hereby affirm that III licensed under provisions of Chapter 9'(commencing with Section
7000) of Division.3rof the Business and Professions Code; and my license is in full force and
effect. q `P �-t-�^'I ''t. A
A.P. Number
Legal Description
Project Description
Sq. Ft. it lin. ft,No. No. Dw.
Size Stories Units
New [q Add ❑. Alter ❑ Repair ❑ Demolition ❑
4 --foot high block M11
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
Rear Setback from Rear Prop. Line
permlt'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
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
Plan-Chk. Dep. -
' subjects theapplicant to a civil penalty of not more than live hundred dollars ($500). ' '
Plan Chk. Bal.
. ❑ I, as owner of -the property, or my employees with wages as their sole compensation, will
Validation:
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 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 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.I'.
- such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑Lam exempt under sec.• 8. & P.C. for this reason
Driveway Enc.
Infrastructure
Date • owner
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 Ownei
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
Ihereby 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 lawsrelating to building
construction, and hereby 'authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicani.�f % F :��A Date
Mailing Address 15 ~"` -7 AV
City, State, Zip 1
HARD COPY
TOTAL
REMARKS
AMOUNT.
25.02
33.5
S50W
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 10" 30"'8'Permit
Validated by:
Validation:
A6603
10 30 64,02 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. ® '
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
S �(f '-a12,0 w
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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
S �(f '-a12,0 w
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
2 OND BEAM ��l /
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
g%
DEC 17 19fJ1
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