09304 (PLBG)P.O. BOX 1504 N o . 09304
78-105 CALLE ESTADO
Addrress -et (?5 Waghjn g _ LA QUINTA, CALIFORNIA 92253
Owner
Mailing - 1` - -
Address saw as above
City Zip Tel.
La' 6 iota " 92253 ►64-- 34
Contractor
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description
Sewer Lateral.
city
Zip
Tel.:
Date Owner-,L�i—�i✓ru'i. :if o �W,
XI—ter—'m
NOTICE TO APPLICANT: Il "a/ter making this (Certificate• of Exemption . you should become
.ZONE:
• BY:
subject to the Workers' Compensation provisigns of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
State Lia
City
Front Setback from Center Line
& Classif.
Lic. #
Sq. Ft.
No.* No. Dw.
Side Street Setback from Center Line
Size
Stories Units -
Arch., Engr.,
work for which this permit is issued. (Sec. 3097, Civil Code.)
Designer
New O Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
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. '
City
Zip
State
Issued by:Date
Permit'
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
Validation:
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following.
T
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires, a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance. also
'
requires 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
Division 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis
for the alleged exemption. Any, violation of Section 7031.5 by 'any applicant for' a permit
- Plan Chk. Dep.
-
• subjects the applicant to a civil penalty of not more than five hundred dollars ($500):
Chk. Bal.
.� I, as owner,of the property, or my employees with wages as their sole compensation, will
.Plan
,
do.the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
Professions .Code: The Contractor's License Law does not apply to an owner of property who _
' builds or improves thereon and who does such work himself or through his own ,employees,
Mech.
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 will,�have the burden
Electrical
of proving that he did not build or improve for the purpose of,sale.) y ..K
O I, as owner of the property, am exclusively contracting with Ijcensed contractors to con-
Plumbing
15.00
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 _
M. 1.
�3
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ;
Grading
w
❑ I am exempt under Sec. B. 8 P.C. for this reason
%
Driveway Enc.
Date Owner*N/
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„may#
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. .
TOTAL
CERTIFICATE OF EXEMPTION FROM
REMARKS
V
WORKERS' COMPENSATION INSURANCE '
(This section need not be completed If the permit is for.'one hundred dollars ($100) valuation
or less.) t,. %
I certify that in the performance ofithp work for which this permit is issued, I shall not
em to an arson in an manna so t b b' t h W k
I y y y r as o ecome_su iecf o t e or ers Compensation
Laws of California. j }
Date Owner-,L�i—�i✓ru'i. :if o �W,
XI—ter—'m
NOTICE TO APPLICANT: Il "a/ter making this (Certificate• of Exemption . you should become
.ZONE:
• BY:
subject to the Workers' Compensation provisigns of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
_
Minimum Setback Distances:
v
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. 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 and validated, 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.
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
T
'
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
2ND FL. SO. FT.
FOR. SO. FT. @
GAR. SO. FT. @
CAR P. SO. FT. @
WALL SO. FT. @
SO 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. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1Y4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR @ 3/ac
HOUSE SEWER
FINAL INSP.
ROOFING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE LPL.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 (C C
(�l59H 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 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 INSPECTIO
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL