12437 (RR)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 48-875 Washington' LA QUINTA, CALIFORNIA 92253
Owner • • Vpnrran
Mailing
Address vMiC4E•3
• City Zip
.La xita,.�: 92253
Contractor. ;
Stk1Un` d Rd6ii:tg
Address'.
34-460 Linda Way
92234
-State LIc
& Class lf Cr 39 579664.
Designer
r Address
City Zip,
Tel:
Tel'2,—,443
City
Lic. # 1724
Tel.
e
No. 124.37.
BUILDING: TYPE CONST: OCC: GRP.
A.P_. Number
Legal Description i }'
Project Description
Sq.` Ft.
Size
New O
N'o. Dw
Units
Repair 0
LICENSED CONT�A • OR's DECLARATION
I herebyy affirm that l am licen"sehnder/pro Sion of Chapter 9 (commencing with Section
7000] 9fDiv ion 3 of the.Busmess•and ProfessionssCode, and my license is in full force and
effect ��i�k ;;r. :, .
f
>_
f<
.
�• _
�J •� - ."
` SIGNATURE �✓ '" DATE
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 orlcounty which requires a
•permit, to construct, alter, improve, demolish, or repair any structure, Il prior to, its issuance also
requires -the applicant for such permit to, 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 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
• . 0 I, as owner.of'the property, or my employees with wages as their sole compensation, will
do the work; and the structure is not. intended or offered for sale. (Sec. 7044, Buisness and
` Professions Code: rThe Contractor's License Law does not apply to an owner of property who
Estimated Valuation $820. 00 J ti
- >.� i�••. _
- PERMIT AMOUNT -
p
- -
-Plan Chk. Dep. -
Plan Chk. Bal.
Const. 313.00 '
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
t
Electrical
- R,�- '
_ ,
or improvement is sold within. one year of completion, the owner -builder will have the burden_
of proving that he did not build or improve for the purpose of sale.)
Plumbing
'
" 0 1, as owner of the property, am exclusively contracting with licensed contractors 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 '-
such projects with a contractors) licensed pursuant. to the Contractor's License Law.)
' '0 1 am exempt under Sec. B. & P.C. for this reason
•
S. M.
r,
-
Grading
-
Driveway Enc.
,!Date Owner r
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.)
Pof Company
? r
• fS Copy is filed with the city. 0 Certified copy is hereby furnished.
".
F..,
TOTAL
Ju. U0 ..
s CERTIFICATE OF EXEMPTION FROM
• WORKERS' COMPENSATION INSURANCE
REMARKS
'
(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 Workeis' Compensation
Laws of California.
-
• �O
NOTICE TO APPLICANT: making this Certificate of Exemptionyoshould .become
• subject to 'the Workers' Compensation provisions of the Labor Code, you must forthwith
comply Will such provisions or this permit shall be deemed revoked.-
ZONE: BY:
Y -
Minimum Setback Distances: .
'
Front Setback from Center Line
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
FINAL DATE
-Issued by:
Validated by:
Rear Setback from Rear Prop. Line
Side Street;Setback from Center Line�..
Side Setback from Property Line 331y..
IN TOR
• r
1 i`
Date- Permit j
_ J
OCTn ry n
C 1 2 ( �1
Lender's Address -
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. f
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 state 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
Walidation:
"" n
Y
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. p $
UNITS
SLAB GRADE
�+ r
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT.
GAS (ROUGH)
METER LOOP
GAR. SO. FT. p
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT.
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN,
SO FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.cu.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
yd: �
$ plus x$
r
=$
LUMBER GR.
FINAL INSP.cu.
FRAMING - -
FINAL INSP.
ROOFING , (-(D —513 LD
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL