003558 (RER)P.O. BOX 1504 N o . ..
Building _ 78-105 CALLE ESTADO >
Address 53-3'60 Vials LA QUINTA, CALIFORNIA 92253.
Owner
Mailirig BUILDING, TYPE CONST.'- OCC'. GRP:
Address 42-215 Tgarnpr: :'rte. A.P. Number- 774-0+$4- 003'
City Zip Tel. < ' _ '
tPi` ... f` m1 �„ ..... g3'1 ien - 3 Legal Description _
Contractor
. .. '- :... .: ... Project Description . �s�r3 �>�.� 'ir&s 3 c-kr•�sy ca# VA�raavtttrs .
.Address pq� �._.. - ... :'. ..• -
78-341 Darby ad ..y h R •' w M M
;...City Zip Tel. _ .
�a 92201 345-13,49...-
State
45-33,49..._State Lic. City ��
& Classif.•., Lic. # Sq. Ft.' No. No. Dw.
400211 Size .Stories . Units
----Arch., Engr.; ... _
..Designer New ❑.• Add ❑Alter 0 Repair.❑ Demolition ❑.
Address Tel.
City Zip State
-. ..... _ Lic. #
..LICENSED CONTRACTOR'S DECLARATION _ y
- 1. hereby affirm that 41am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 offthe Business and Professions Code; and my license is in full force and '
- effects• ��. 'r'^-•-` r+. . � . .. .. -. .. . ,. ,
SIGNATURE ? f 'l. 'Y 6 a DATE
'OWNER-BUILDER DECLARATION Estimated V81Uatlon G
I hereby affirm that ram exempt from the Contractor's. License Law for the following,ld2 •� t -
reason: (Sec. •70315,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 N ' *d! 4w'
requires the applicant for such permit to file 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 sr. -
" 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- Plan-Chk:.Dep.
subjects the applicant to a civil penalty'of not more'than' live hundred dollars ($500). - - -
Cl I, as owner of the property, or My.employees with wages as their sole compensation; will - Plan. Chk 881.
do the work, and the structure is not intended or offered for sale: (Sec. 7044, Buisne-ss and. .ry
Professions Code: The Contractor's License Law does not apply to an owner of; property who const, • ky �.� ��� },
builds. or,imp roves thereon and who .doesauch work-himself or through his own employees,
such '
•, provided that such improvements are, not intended oro/lered:for sale. I/,, however,, the building `
or improvement is sold -within one year. of completion, the owner-builder will have the, burden " .. ' • .. i
of proving that he, did not build or, improve for the purpose of sale.)EI@CtrIC81•'-
❑ 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 -
-' 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.) - -
❑.I am exempt under Sec.... - B. t> P.C. fokGrading
this reason -
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1. 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
.O Copy is filed with the city., O Certified.copy is hereby furnished: , . ... .
TOTAL
CERTIFICATE OF EXEMPTION FROM .REMARKS
WORKERS' COMPENSATION INSURANCE.
(This section need not be completed if the permit is /ozone hundred dollars ($100) valuation - �' ♦«r
.-or less:) :.... .. .. . _ _
certify that in lhe.performance of thg workfor which this permit is issued, I shall not Tr_.f•ft.•: ' ,7 ..utk ".)q?;f{�`
•''employ-any person in any mannerso 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 of the--Labor Code,' you 'must 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 that1here is a construction lending agency for the performance of-the
work for which this permit is issued. (Sec. 3097, Civilcode) t .. Side Setback from. Property Line
Lender's Name
Lenders 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.
I certify that I have read this *application and state that the above information' is correct. Issuedby: Date t F 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 A • Date
Mailing Address ,Validation:.: '
City, State, Zip
.. Y., HARD COPY r . f
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
FOR. SO. FT. ®
GAR. SO. FT. ®
CARP. SQ. FT. p
WALL SQ. 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
BONDING
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.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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 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
1 UM'J WUNA 1 UMtJ11M111AUk
GARDEN WALL FINAL
T ') L.%! ;S II