001927 (SIGN)P.O. BOX 1504 No. 001927
Building 78-105 CALLE ESTADO
Address 48-680 "a�LA QUINTA, CALIFORNIA 92253
Owner .. , .� .... .. _ _ ...
�¢ BUILDING: TYPE CONST. OCC: GRP.
Mailing "
Address VA. YVf,; nvr-- A.P. Number. 627-28,3—C44
City Zip Tel.
Palo-AILO 9490. Legal Description
Contractor Project Description
nemxt Sims :�She �3
igM
...Address ... .. :... ... .. ...
City
,Pain
Tel..
Pam, � 92262 328-6275. Sw Tbrait M. 001902
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
- Arch., Engr.,
Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ - Demolition ❑
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 ss
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
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, demolish, or repair. any structure, prior* to its issuance also - r•
requires the applicant, for such permit to file a signed. statement that be is licensed pursuant to PERMIT " - _ - - AMOUNT -
the provisions ofcthe Contractor's license Law, Chapter9 (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 7031.5 by 'any applicant for a permit PlariChk. Dep.. "
'subjects the applicant to a civil penalty ofnot more than five hundred dollars ($500). •' - . L ' - -
0 1, as owner of the property, or my employees with wages as their sole compensation,, will PIan.Chk. Bal.
do the work, and the structure is not intended or offered for sale.. (Sec. 7044, Buisness and COflst..
Professions Code: The Contractor's License Law does not apply to an owner of property who
'builds or improves thereon: Law.
and who does who work himself or. through his own employees,.
MeCh. .- -
provided that' such improvements are not. intended or offered for sale. It, 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.) ..
❑ 1, 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
does not. apply to an owner or property who builds or improves thereon, and who contracts for S. M.I.
-
such projects with a contractors) licensed pursuant to the Contractor's-License Law:) -
O I am- exempt under Sec. B. & P.C. for this reason Grading
Driveway Eno.
Date Owner Infrastructure
Tmift-qtifirktim _P 340.73
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. . " I Company
❑ Copy is filed with the city.. ❑ Certified copy is hereby furnished..
TOTAL 340.71
CERTIFICATE OF EXEMPTION FROM REMARKS.
'
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is'for one hundred dollars ($100) valuation - S
• or less.) _ a,�,
I certify that in the performance of tha work for which this permit is issued, I shall not rb ,eti)irgyp"m—a �!-ma � eamwh gam,. ,rR{ 1"4'
employ any person in any manner so-as to become subject to the Workers' Compensation
Laws of California.f-�
Date ' ' Owner
NOTICE TO APPLICANT: If, after making this -Certificate of Exemption you should become ZONE' BY:'
'subject to the Workers' Compensation provisions of the Labor Code; you mush. 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
.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
This is a building permit when properly filled out, signed'and validated,'and is subject to FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 180 days; �.
1 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 -x•
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
A 3 5 1 2 12 9 34L'73 CK
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBe4G FEES—
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ, FT. ®
CAR P. SO. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
REMARKS:
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 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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
m arca. i un a ownh 1 —01-11 iwa,a,
GARDEN WALL FINAL