001977 (BLCK)Building r
Address 52-510 1itieni& DUZ
Owner
D Debonh1
Mailing
Address 510 AVeni4a D3=
City Zip
La Wi&A 92253
Contractor
_. Aaaress
•444
�j.
P.O. BOX 1504 No. .001977
0.97?
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING:- TYPE CONST. - OCC: GRP.
A.P. Number�� .
Tel.
564-6654 . Legal Description tot 2. Blk 16, M 48/046 Swita
. ... eta Vii - T• Wintar Ubit i
Project Description
MM W1, - 233.78 14a. it. of P'imm*r
City.
Zip
Tela
VER A MICTf�.3', F!PPROM PTMW
State Lic.
City
& Classif.
Lic. #
Sq. Ft.
No. No. Dw.
Size
Stories Units
Arch., E'ngr.,
Designer
New ❑ Add ❑ Alter ❑ Repair ❑. Demolition ❑
Address
Tel.
City
Zip
State
L•ic. If
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
l effect..
'
_ • " _
_SIGNATURE' �-^- +" DATE
OWNER•BUILDER DECLARATION
I 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
"repair
Estimated Valuation
} ire
!!�f 9,c 0 00
$ I.1 '
PERMIT
-
AMOUNT
permit to construct, alter, improve, demolish, or 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
' 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 mare than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will.
Plan Chk. Dep.w
'
Plan Chk. Bal..'
Const.
�•�. t`�y
I• do the work, and the structure is not intended or offered for sale. (Sec. '7044, Buisness*and
I Professions Code: The Contractor's License Law does not apply to an owner• of property who
"who
Mech. -
f builds or improves thereon and does such work himself or through his own employees,
r provided that such improvements are not intended or offered for sale. If, however, the 'building
w-or;improvement is sold within one year of completion,- the owner -builder will have the burden
Ofproving that he did not build or improve for the purpose of sale.)
EleCtrlcal '
Plumbing
.0 I, as owner of the property, am exclusively contracting with licensed contractors to'con-
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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) •�
ClI am exempt under Sec.. B. & P.C. for this reason
•S.M.I. •
_53
Grading
Driveway Enc.
Date -owner s -
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
CERTIFICATE OF EXEMPTION FROM
WORKERS'.COMPENSATION INSURANCE .•
REMARKS
(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 th0 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
subject to the Workers' Compensation' provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. -
- ZONE: BY:
.Minimum Setback Distances: -
Front Setback from.Center Line
I
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 andvalidated, 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 laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-:
mentioned property for inspection purposes.
Issued by:.
Validated by:
Date 'Permit
Signature of applicant Date
Mailing Address
Validation:
A3736
1 7 11353 CK
City, Slate, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. S0. FT.
FORM S ,
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOMESVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT "
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN
SO FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
LATHING
SO. FT. ® c '
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 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
FORM S ,
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$ -
=$
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 SIGNATURESIINITIALS_
GARDEN WALL FINAL