9463 (PAT)• �` .
P.O. BOX 1504 'ti•Y"' N 0.' 9463
Building .78-105 CALLE ESTADO '
Address '44340' Willow Circle LAQUINTA,`CALIFORNIA92253 { r
. Owner
jack R. Schreiber
Mailing BUILDING: TYPE CONST. OCC: GRP _
Address same
A.P. Number
City Zip Tet
La Quinti - -. 92253 360-2221 Legal Description
Contractor Project Description P, -wt in .Q`_nvPr
Address
City Zip Tel.: ,
r ,
State Lic. City
& Classif. Lic. # Sq. Ft. 6.16 No. No. Dw.
Arch., Engr., Size • " 'Stories Units
Designer New ❑ Add' ❑ - Alter ❑ • Repair. ❑ Demolitiori.❑
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 t.
A hereby affirm that.l am exempt from the Contractor's License Law for the following 7638.00 W
n
;y. ,reason: (Sec. 7031.5,Buslness and Professions Code:. Any city or county which 'requires a • -
,,reason:
to construct, 'alter, improve, demolish, or repair any structure, prior to its issuance also
d •srequires the applicant for such .permit to rile 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 . -
rce 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 Iby,eny:applicant fora permit Plan Chk.'Dep.. .. ..
subjects the applicant: to a civil penalty of not more than live hundred dol/ars.(8500). , • -"'
?h, as owner:of the property;,or.my employees with wages as their. sole compensation„will Plan Chk. Bal. 64} 9 '25,
he work; and.the structure -is not intended, or offered for sale: (Sec:: 7044. Buisness and
Professions. Code: The, Contractor's.Ucense Law does not apply to an owner.of,property who 'Const..' 99* GO
builds or improves; thereon and who does such work himself or through his own employees, - 'Meeh..- '
.,provided that such Improvements are not Intended or offered for sale. If, however, the budding- ,
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.)WA
_
O I, as owner of the property, am exclusively contracting with licensed contractors to coo- Plumbing L•
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 S.M8.0 '
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.), -
O 1 am exempt under Sec: B. 8 P.C.'forthis reason
Grading ”
,f !l r? „� Driveway Enc.
Date�Tlr 'vwher -_�. t,� °jiV_GA, Infrastructure
WORKERS' COMPENSATION DECLARATION ' "'-' Y''
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 16-4.15 r*,:.
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE ' . .
his section need not be completed If the ' • "^
R p permit is for one hundred dollars (8100) valuation - • -, t -•
or less.) .i ° E .Q f i (^ `g j i Q "j
I certify that in the performance of the work for which this permit is issued, I shall.not' i n+",F l- �,�n
employ any person in any manner so as tobecome. ubject to the Workers"Compensation'
Laws of Califoc, ia. r �.
Date ,/..:1 Ower &,4o :i37 �f S iri rC, r t �i•lL G.i'�Z: '
NOTICE ,TO, APPLICANT::after making this Certificate^o! `Exemptlon -you should become ZONE: ' BY:
subject to the •Workers' -Compensation provisions of The Labor Code, you - must. forthwith Minimum Setback. Distances: - -
comply with such, provisions 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
Ihereby 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 Llne
Lender's •Name
r
Lender's Address a `
• ;This is a buildin FINAL DATE INSPECTOR
g permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days. ` I
l certify that have read this applicatiowand 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. Validated by:
Signature of applicant ` Date
Mailing Address'- - 'Validation: '
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. SQ. Ff.
WALL SQ. Fr. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. Fr. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Vi c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 314c
HOUSE SEWER
FRAMING
FINAL INSP.
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 Z PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR'
SETBACK
Uy
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 APPJEQUIP.
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 SIGNATURESlINITIALS
GARDEN WALL FINAL