002300 (BLCK)• ' 1. .. • �� , , .
P.O. BOX 1504 No..
Building 78-105 CALLE ESTADO
Address 52-230 Avenida VIUM LA QUINTA, CALIFORNIA 92253
Owner •
Mailing . .._ .
Address V3A ,n
City Zip Tela
92
Contractor
Ste.
Address
_City ..... Zip Tel.'
Rx�r�ea
BUILDING:' TYPE CONST. OCC:.GRP.• '
A.P. Number 773^274-2
Legal Description
Project Description '
State Lia
& Classif:.. - - "� ' ;.t
City
Lic. #Ff ,er .
_r,.•..
Sq. Ft.
No. - No. Dw.
ZONE:'
t-9
Size -
Stories Units
' Arch., Engr., --
Rear Setback from Rear Prop. Line
Designer
New ❑ Add ❑ •
Alter ❑ Repair ❑ .• Demolition ❑
Address
Tel.
FINAL DATE
INSPECTOR
Issued by:
Date &-H Permit.
Validated by:
City
Zip
State
A5221
4 14. 34-32 R
Lic. #
LICENSED CONTRACTOR'S DECLARATION .. . .
hereby affirm that I,am licensed under provisions of Chapter 9 (commencing with Section
7000) of Divisio�nr3 offthe and Professions C,odle anddmmy license is in full force and
r '
�Busineess
effect.. • A .4i/ Fl. t ie;_e re
SIGNATURE f `-•'•"'- "'�1• d'' DATE
-OWN ER.'BU ILD ER,bECLA RATION
Estimated Valuation
F hereby affirm that I am exempt from the Contractor's. License Law for the following
•
� �t,
.h 1,22S.QV '
., reason: ,(Sec., 7031.. 5, Business, and Professions• Code: Any, city or county which requires a'
*to
permii construct, alter, improve, demolish, or repair any structure,• prior to its issuance also
the applicant for such -permit to file a signed statement that.he is licensed pursuant to •.
PERMIT •'
%r, AMOUNT -
- ^
therequires
the provisions of the Contractor's License Law, Chapter 9 (commencing with -Section .7000) of
t
D10sion'3 of the Business afid"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..per&I
Plan•Chk., Dep.,.
' subjects the applicant to a civil penalty ofnot more than five'hundred-dollars ($500): ' .'
Plan Chk.. Bal.
• . ' -
��
O I, as owner of the property, or,my employees with wages as their sole compensation, will -
'the
� _� ,.
dowork, and the structure is not intended or offered for sale..(Sec. 7044,"Buisness and
Const..
u
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 suchimprovements 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.) ... - .-
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
-struct the project. (Sec. 7044, BusinessandProfessions 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.) -
Grading
O 1 am. exempt under Sea B. 8 P.C. for this reason -
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
Thereby affirmkthatI 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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S 100)1• valuation
•' or less J. .. _
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
subject to -the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
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
Lender's Address
Tnis'isra 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.'
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 purpos
`Y.es.
Signature of applican + �
Mailing Address . A_ _ ._ •• ,✓- i -
City, State, Zip f
nAnu [:VPY
TOTAL 34.32
REMARKS' -
ZONE:'
BY:
Minimum Setback Distances -
Front, Setback.from .Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date &-H Permit.
Validated by:
Validation:
A5221
4 14. 34-32 R
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. S0. 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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FOUND. REINF.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
IKITCHEN 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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
/
LUMBER GR. ( /(/ VC _
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
= ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
I V M'J wumA 1 unrwIIYI I IAID,
GARDEN WALL FINAL
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./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
/
LUMBER GR. ( /(/ VC _
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING S
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
I V M'J wumA 1 unrwIIYI I IAID,
GARDEN WALL FINAL