002030 (BLCK)P.O. BOX 1504 No. 0030
Building 78 105 CALLE ESTADO
Address52-3W AVMide Diaz LA QUINTA, CALIFORNIA 92253
Owner
g� BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address. A.P. Number 773-25.2-04r`
City Zip Tel.
• Legal Description Tat 18
Contractor Project Descriptionkttax�xtictt�]-
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$ ft high
.Address '
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i
City Zjp Tela
Atv
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
i Designer New p, Add ❑ Alter ❑ Repair ❑ . Demolition ❑
Address Tel.
City
Zip
State
Lic. #
V
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,
1 hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
reason: (Sec. 7031.5,Susiness and Professions Code: Any city or. county which requires a -
- -
.PERMIT
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
-
Plan Chk. Dep. .
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 hundreddollars ($500).'
p 1, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk• Bal.
Const.
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
-who
Mech. .
builds or improves thereon and does such work 'himself or through his own employees, -
- - provided that such Improvements are not intended or offered for sale. If, however, the building
Electrical
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.) -_
-Plumbing
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
stfuct 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 contractors) licensed pursuant to the Contractor's License Law.)
• . ❑ 1 am exempt under Sec.. - B. & P.C. for this reason-
, �t ,
`
Grading
Driveway Enc.
j
Datei w �f'w Owner fi;'41014># l'z''I
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.)
Poky'No. Company
❑ Copy.is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
or less.) '
I certify that in the performance of the 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 youshould 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.
REMARKS -
AMOUNT
19.11
29-.50
.- Ch
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) - 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 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. q j - + Validated by:
Signature of applicant �t y f%+flid 7l 1' AI.,, d�' Date
Mailing Address
Validation.
City, State, Zip
' A4101
HARD COPY 4 9, 1 2)f
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
'2ND
YARD SPKLR SYSTEM
FL. SQ. FT. @
HEATING (ROUGH)
STORAGE TANK
ORMS /' rG
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. Q. FT. ®
GAS (FINAL)
WALL SQ. FT.
DRINKING FOUNTAIN
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
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
ORMS /' rG
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
��
(�SOND BEAM Z
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL