003034 (BLCK)P.O. BOX 1504
Building 78.105 CALLE ESTADO
Address 53-248 Avenida Diaz LA QUINTA, CALIFORNIA 92253
Owner
Malting
Address p. u.B= 2702
City Zip Tel.
Palm D"eTt -92261 345-73512
Contractor
R�rA2acx� tw>;.�>a� tTA�+afi•� �'�.
Address
:�. 0. Box 2702
No. QQ�34
BUILDING: TYPE CONST. � OCC: GRP.
A.P. Number 774-042—W7
X37
Legal Description
Project Description SID, of 31 pir& Rp'tAlf) sap WAII.
State Lic.
City
& Classif. 473053
Lic. # 784
Sq. Ft. 50
No. No. Dw.
Size
Stories Units
- •'Arch,, • • ' -
Engr.,
'
Designer
New Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED,.CONTRACTOR'S_OECLARATION
M
I hereby affirm that I am licensed under provisions of Chapter, 9 (commencing with Section
7000) of Division 3 the Business Professions Code,
7 of and and" s In full force and
effect. /ff rsx; ense i ..
E DATE -
.. ..
..
✓
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby'afflrm that I am exempt from the Contractor's License Law for the following
��5� 00.
reason: (Sec. 7031.1,Buslness and Professions Code: Any city or county which requires e
permit to construct, alter, Improve, demolish, or repair any structure, prior to Its Issuance also
+
requires the appllcant.for such permit to file a algned.statement that he Is llcensod pursuant to _
the provisions of the Contractor's License Law, Chapter9 (commencing with Section 7000) of c
PERMIT
AMOUNT
Division 3 of the Business and Professions Code, or that. he la exempt therefrom, and the basis "_
for the alleged exemption. Any violation of Section 7031.8 by' applicant for a permitPlan'Chk.
Dep.
subjects the applicant to a civll'penaay of not more than five hundred -dollars ($500).
Plan. Chk. Bal.
❑ 1 as owner of the property, or my employees with wages as their sole compensation, will
i - do the work, and the structure ie not Intended or offered for sale. (Sac. 7044, Suisness and
{ Professions Code: The Contractor's License Law does not apply to, an owner of property who
Const.
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 for sale. If, however,. the building
or, improvement Is sold within one year of completion,the owner -builder willhave the. burden
Electrical
of proving that he did not build or Improve for the purpose of sale.)
,
O I, as owner of the property, am exclusively contracting with licensed contractors to con.
..:etruct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Low
Plumbing
does not apply to an owner of property who builds or Improves thereon, and who contracts for
S. M. 1.
RA
such projects with a contractor(s) licensed pursuant to the Contractor's License Low.)
Grading
m m
O I e exempt under der Sec. B, & P.C: for this soon
i
'
Driveway Enc.
i Date owner �
Infrastructure
WORKERS' COMPENSATION DECLARATION
X ' /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
0 Copy Is filed with the city. Q Certified copy is hereby furnished.
TOTAL
$iii •5f3
CERTIFICATE OF EXEMPTION FROM
{ WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed If the permit Is for one hundred dollars ($100) valuation
Orissa.)' -
I certify that In the performance of the work for which thie permit Is Issued, I shall not
r
employ any parson In any manner so as to become subject to'the Workers' Compensation
Laws of Cellfornla.
Date " . Owner
l 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
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
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit Is Issued. (Sec. 3087, Civil Codes,
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. •
t=�7
I certify that I have read this application and state that the above Informatlon Is correct:
Issued by;
!
Date Permit
I agree to comply with all city and county ordinances and state Tawe relating to building
construction, and hereby authorize representatives -of this city to enter theabove•.
mentioned property for Inspection purposes,
Validated by:
Signature of applicant Date
Melling Address
Validation:
City, State, Zip
A7b99
4 7 2 0 5 b it
HARD COPY
T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEtS
1ST FL. SQ. FT. @ $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2 ND FL. SQ. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
FOR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. @
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
/
DAMP. POLE
DRAINAGE PIPING
CAR P. SQ. 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
VENTILATION
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.
SQ. FT. @ c
BATH TUB
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ tl/a c
SEWAGE DISPOSAL
SQ.FT.GAR @ V4c
HOUSE SEWER
FINISH GRADING
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)
/
DAMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
.$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING.
FINAL INSP. -,
ROOFING
DEC
.• v.
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
'..