003183 (PAT)� CL•
Building
Address
Owner
Mailing'
Address
City
P.O. BOX 1504 NO.�
78-105 CALLE ESTADO
79-805 r7astvard II. Thrive LA QUINTA, CALIFORNIA 92253
Keith C. Pa firmer
Zip ITel.
T.t3 0"- IntA F C17%'A I 1fi _3inF;r4
Contractor
Address. ... - .
City Zip Tel.•..
BUILDING: TYPE CONST. . . • OCC: GRP.
A,.P,Number 417d3'4lIIII-1;
Legal Description ' 4` f
P
roject, Description 'tat Q
f
F
State Lic.
City
& Classif'.
Lic. #
Sq. Ft. -
No. No. Dw.
Size -Stories Units .
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition:❑
-
Arch:, Engr. .. .
Designer
Address
Tel.
City
Zip
State
Lic-#
r'
s
LICENSED CONTRACTOR'S DECLARATION •
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 -BU ILDER DECLARATION
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 -
permit to construct, atter, improve, demolish, or repair any. structure, • prior to .its issuance also.
requires 'the applicant. for.:such permit to lila 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 Bushies's'and Professions Code,. or'thaChe 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'more than live hundred dollars'($500).. -
O I, as owner of the property, or my employees with wages as their -sole compensation, will, .
'
Estimated Valuation,
E.
{.
c PERMIT
• . as -
- AMOUNT
Plan .Chk. Dep. • .
-.
.. '
'Plan' Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to. an .owner- of property who
Mech.
builds or improves thereon and who does such work himself 'or through his own employees, -
provided that such improvements are not intended- or, offered for, sale. If,. however„ the. building
or improvement is sold within one year of year the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.) ..
EI2CtrICa1 "
-
Plumbing
-❑ 1, as owner of the property, am exclusively contracting with licensedcontractors 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
...
S.M.1. -
- -such projects with a contractor(s) licensed pursuant to the Contractor's -License Law.)-
'
0 I. am exempt under Sec.- B. & P:C. for this reason
Grading
Driveway Enc.
Date '�4owner Ir 1-4 a ..
Infrastructure
WORKERS' COMPENSATION DECLARATION '
hereby affirm*that'l 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.)
- polio No. Com any
y v
O Copy is filed.with the city. O Certified copy is hereby furnished.
s e r
3. , , E1',,w' .
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TOTAL:
00AM
_
REMARKS.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE = .... :.
(This section need not be completed if the permit is for-one:hundred-dollars ($100) valuation
• or less.) .. .. .. _ .. _
certify that in the performance of the 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.
-
- - -
Datewner
NOTICE TO APPLICANT ll, 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:
Minimum Setback
BY: '
Distances: '
' '•
Front. Setback'from Center.Line
Rear Setback from Rear. Prop. Line
CONSTRUCTION LENDING AGENCY-
I hereby affirm that theie is a construction lending agency for the performance of the
work for which this permit is issued. (Sec: 3097, Civil Code.) .
Side Street Setback froftCenter Line
Side Setback from Property, Line
Lender's Name
FINAL_DATE'
Issued by:'•
Validated by:
INSPECTOR
Date-�l94f,R-7 Permit
`
Lender's Address
This'is'a building validated,.and when properly filled out, signed and validatedand 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 stale 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 Address
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
2ND FL. SQ. FT.
POR. SQ. FT. @
GAR. SQ. FT. @
.CAR P. SQ. FT.
WALL SO. FT. @
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
7
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
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
REMARKS:
VENTILATION
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.IEQUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL