06251 (BLCK)Iding
Iress 77-175
c&ty/ 4 4v Q”
:10nica VaLmcia
City lZip
P:O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Contractor I
Omer/Builder
State Lic. I CiLic. ty
& Classif. #
Address
City IZip ISt to F
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Ision 3 of the Business and Professions Code, and. my license is in full force and
effect.
SIGNATURE DATE
OWNMBUILDER DECLARATION
1 hereby affi0n that'I am exempt from the Contractor's License -Law for the following
reason: (Sec: 7031.5,8ushass and Protossions Code: Any city or county which requires a
Permit to construct, after, improve. •dernoHsh. or repair any structure, prior to Its issuance also
requires the oppdcard for such permit to Me a signed stateunent that he Is licensed pursuant to
the provisions of the Conhactors ticense Law. Chapter g (commencing _with Section 7000) of
Division 3 of the Business and Prolesalans Cade, or that. he Is exempt therefrom, and the basis
for the a0eged exemption. Any vJdetion o1 Section 7031.5 by any applicant !ore pemrft
suDJecfa the applfcant to a civlf penalty of not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole. compensation, will
do the work, and the structure is not Intended or offered forsale. (Sec. 7044, Sulaness and
Protessions Code: The Contractor's License Law does not apply to an owner of property who
bu is or improves thereon and who does such work himself or through his own employees,
provided that' such snprovements are not intended or offered for sale. M however, the building
or Improvement Is said within one year of completion, the owner -builder will have the burden
of provirrg.that he did rat bulid or Improve for the purpose of safe.)
❑ 1, asowner of the property, am exclusively contracting with licensed contractors to con•
struct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to anownerof property who builds or brproves thereon, and who contracts for
-such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. R„g P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
❑ Copy Is filed with the city. ❑ Certified copy is hereby,fumished.
CERTIFICATEOF EXEMPTION FROM
WORKERS'COMPENSATK)NINSURANCE
(Rds section need not be coopreted N the permit is for one hundred dollars ($ 100) vafuation
or lose.)
I certify that in the performance of'thg work for which this permit is Issued, I shall not
employ anyppeerson In any manner so as to become subject to the Workers' Compensation
Laws of Califemia.
Date Qwner
..NOTICE TO APPLICANT. It, after m&0V the Certificate of Exemption you should become
subject to the Workers' Comparmwn provtsrons- of the labor Code. you must forthwith
Comply with such provisions or this permit shelf be deemed. revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction leading agency for the performance of the
work for which this,permil is Issued. (Sec. 3087, Civa 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 1110 days.
I certify that 1 have read this application and state that the above information Is correct.
I agree to comply wlth.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.
Signature of applicant Date'
Mailing Addrasa
city, state, zip
No.
NG: TYPE CONST. OCC: -GRP.
Number 773-2014ZIS
06251
Legal Description
Project Description 1401 X 6' wood feline-sideyard
Sq. Ft. No. ' No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
mated
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
��ag.Ofl
•14
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 911%�3g Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® =
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT.
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SO FT @
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION S
=i
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)1DISM
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
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. a c
BATH TUB
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 % c
SEWAGE DISPOSAL
SO.FT.GAR ® iGc
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE 111PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. I 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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus xi
=i
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
INAL INSPECTION1177�22
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL