001633 (AC)P.O. BOX 1504 No. 00163A,3
Building 78-105 CALLE ESTADO
Address 47-225 Washingtm St. LA QUINTA, CALIFORNIA 92253
Owner
Zip
92260-
State
Lic. #
to'ecidstim
Church of St. Francis
of AWiSi
BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address
42-600 BobMPG Dr.
Suite 425
617 070 Q2
'
- - PERMIT"
- -
.Plan Chk. Dep..
Plan 'Chk: Bal.
A.P. Number
City
Zip
Tel.
*�
mixage
92270
568-94U
Legal Description
Project Description.
Contractor t
Aaaress n
C7i(tYCt
City(i
t 'e(A0 Y't\0,
State Lic.
& Classif.
Arch., Engr.,
Designer
Address
73-700 1W
900,D3
City
Lic. # Sq. Ft.
Size -
New ❑
Tel.
568-94U .
No. No. Dw.
Stories_ Units
Add I% Alter ❑ Repair ❑
City
riam De'.
Zip
92260-
State
Lic. #
to'ecidstim
LICENSED CONTRACTOR'S DECLARATION
(This section need not be completed if the permit is for one hundred dollars (S100) valuation
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
I certify that in the performance of thg work for which this permit is issued, I shall not
OWNER -BUILDER 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, alter, improve, demo
mit lish, or repair any structure, prior to its issuance also
requires the applicant for such perto file 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 Business and'Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 703 1. 5 by 'any applicant for a - permit
subjects the applicant to a civil penahy of not'more than rive hundred dollars ($500).'
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
Estimated Valuation
'
- - PERMIT"
- -
.Plan Chk. Dep..
Plan 'Chk: Bal.
COr1St.
'
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
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.)- _
O I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law w
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I.
such,projects with a contractor(s) licensed pursuant to the Contractor's License Law.) .
Grading
.. ❑ 1 a exempt under Sec. B. & P.C. for this reason '
Driveway Enc.
Date owner 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
❑ Copy is.filed with the city. , ❑ Certified copy is hereby furnished. '
TOTAL
Demolition ❑
AMOUNT
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S100) valuation
or less.) -
I certify that in the performance of thg 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.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
ZONE:
BY:
subject 'to the Workers' Compensation provisions or 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. 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
r
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 I ` `-
Validation:
A_2008
7 19 x.57,52 Sl
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
A.C. UNIT
2ND FL. SQ. FT.
SLAB GRADE
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
SEWER OR SEPTIC TAN K7�
DRAINAGE PIPING
WALL SQ. FT.
DUCT WORK
DRINKING FOUNTAIN
SQ. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
REINF. STEEL
FLOOR DRAIN
MECHANICAL FEES
TEMP. POLE
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER HEATER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
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
REMARKS:
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
FIREPLACE
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE I PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING 7 O?J
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TAN K7�
TROUGH 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
®rr
• � �_947
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
NSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL
i
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