001975 (BLCK)4
P.O. BOX 1504 No. 001975
Building 78-105 CALLE ESTADO
Address 52-425 ANImia Diaz LA QUINTA, CALIFORNIA 92253
Owner
Mailing
TV,-",kT4Wr4W3,_, BUILDING: TYPE CONST. OCC: GRP.
- •
Address Sam
A.P. Number
City Zip Tel.
. TA ;lam .. 92253 1 Legal Description
Contractor Project Description
. C�f�1tiDI'
Address -
57.
.
City ]Zip . Tel... W
57. T1s febWf stucco fez=.. .
I
State Lic. City \
& Classif. Lic. # Sq. Ft. No. No. Dw.
Size Stories - Units
Arch., Engr.,
Designer New O 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 Contractors License Law for the following i
$ 9 * 0
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a �'yi&25•A
3,t
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 of the Contractor's License Law, Chapter.9 (commencing with Section 7000) of '
Division 3 of the Business and Professions Ccde, 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 the applicant to a civil penalty of not more than five hundred dollars ($500).'' -'
0 I, as owner of the property, or my employees with wages as their sole compensation, will Plan Cfik. 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 ad owner or property who
builds or improves thereon and who does such work himselr'or through his own employees, Mech.
provided that such improvements are not intended or offered for sale. lf,,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. 704.4, Business and Professions Code: The Contractor's License Law �,n
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.)
_ ❑ I am exempt under Sec. B. & P.C. for this reason Grading
Driveway Enc.
Date Owner r r `__. 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. I Company
O Copy is filed with, the city. O Certified copy is hereby furnished.
TOTAL 24.00
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit is for one hundred dollars ($100) valuation -
'orless-)• - -
I certify that in the performance of thq 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 you should become ZONE: • BY:
subject to the Workers'- Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply withsuchprovisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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 LI_fl.e
Lender's Name
Lender's Address
This isa building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
expiration it work thereunder is suspended fcr 180 days.
I certify that I have read this application and state that the above information is correct. Issued by: Date —8 Permit
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. Validated by:
Signature of applicant L - _Date -
Mailing Address %� Validation:
City, State, Zip
A3b%4 12 31 24,00 CK
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. p $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
ROUGH WIRING
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SQ. FT.
HEATING (FINAL)
WALL SQ. FT.
REINF.STEEL
DRINKING FOUNTAIN
SQ. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
SERVICE
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FRAMING
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
SPARK ARRESTOR
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
FORMS
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.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
c$
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 SIGNATURES/INITIALS.
GARDEN WALL FINAL