003780 (BLCK)P.O. BOX 1504 No. 003780
Building 78-105 CALLE ESTADO
Address .53-950 VILLA LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address IR07 1 147Q
City Zip T�7564-7411_
A . WOTA.. ' 92253
Contractor
1< PrW.AT,n1R
Address W .
City Zip Tel: -
BUILDING: TYPE CONST.- • OCC: GRP.
A.P. Number :74. 174-010 -
Legal_ Description
Project Description RETAU111M WALL 4 TWIN 11IIM
State Lic. City
& Classif: Lic: # 1.114 • Sq. Ft. No. No. Dw.
. _.
Size Stories Units'
Arch.; Engr.,
. DesignerNew ❑ Add pl Alter ❑ Repair ❑ -Demolition 0
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
70 00) of Division 3 of the Business and Professions Code, and my license is in full force and
effect
-AMOUNT
4.
2`Sef=2
33.50
C:S
Date Owner
, ,.
SIGNATURE >' s rs DATE
' OWNER -BUILDER DECLARATION �'" r e.
' I hereby affirm that I am exempt from the Contractor's. License Law�f'or-the following
reason: (Sec. 7031.5,Business and Professions Code: :Any city or county which requires, a
'
•, .. ._
Estimated Valuation
'
PERMIT - -
^ permit to construct, alter, improve, demofish, or repair any structure; :prior>to. its' issuance also
requires the applicant for -such permit to ripe a signed statement.that he is -licensed pursuant to
the provisions .of the Contractor's License Law, Chapter 9 (commencing' with Section 7000) or
' Division 3'of the'Business and Professions. Code, or that. he Is exempt therefrom;.- and the basis
for the. alleged exemption. Any violation-bf 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).
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 offereclAor sale. (Sec. •7044, Buisness and
Code: The Contractor's License Law does'not apply to an owner of property who
Plan Chk, Bal.
Const:Professions
MEiCh. '
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
Elect•rical
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-
. structsthe 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. 8 P.C. for this reason -
..
Grading
Driveway Enc.
i it
-AMOUNT
4.
2`Sef=2
33.50
C:S
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'
0 Copy is filed with the city. . 0 Certified copy is hereby. furnished.
TOTAL
i it
CERTIFICATE OF EXEMPTION FROM
REMARKS'
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is .for one hundred dollars ($100) valuation
i #i{� ,it•.•i�A 4 7
'.f'taf5y ��`Tyy'ti
.. or less.) .. ..
I certify that in the performance of the work for which this permit is issued, I shall not
y'a,71�4 y�
JeYk/!^..y{
.: .#17 .. •L1Y7a�i'I ktJf fit. 1 ty.t}�,. ,
• -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 .of 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
hereby affirm that there is'a construction lending agency for therperforrrance of the
work for which this permit is issued. (Sec. 30971 Civil Code.)
Side Setback from Property Line
Lender's Name
Lender's Address
FI NAL' 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
'
4/6/811
read this application and state that the above information is. correct.
'and
Issued by:"
Date Permit
I agree to comply with all .city and county ordinances 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
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING EES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. p
POR. SQ. FT. ®
GAR. SO. FT. ®
CARP. SQ. FT.
WALL SQ. 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,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.
SQ. 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 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
TUH'S WUNA I UNtSIINITIALS.
GARDEN WALL FINAL