003617 (BLCK)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 53-830 Villa LA QUINTA,,CALIFORNIA 92253
Owner
James Laler Trust
No.: 0.036.7
Mailing - BUILDING: TYPE CONST: OCC: -GRP.:
Address3� A.P. Number i9e��-1-•fi�1�i
City Zip Tel.
...J.T3tc:'.. 92253 6,4 4.40 . Legal Description
Contractor. Project Description 250'
pike.' Creek
Address ... raasartriti7a
City
Zip.. ._
Tel.
State Lic.
City
& Classif.,..
Lic. #
Sq. Ft.
No. No. Dw.
Size ..
ries .. Units.
Stories
Arch:, Engr., ... _.
Designer _
New ❑ •Add'❑
Alter ❑ Repair ❑ Demolition 0
Address
Tel.
City
Zip
State
Lic..#
. LICENSED CONTRACTOR'S DECLARATION
hereby affirm that I am licensed under provisions of Chapter (commencing with Section '
. 7000).of Division 3 of'the Business and Professions. Code, and my license is in full force ahtl '
effect..x+ .�.
'
SIGNATURE___-.-..-.__.__�.:.. _ _ _ .Kx .. .'DATE
• .
OWNER -BUILDER DECLARATION
'I
Estimated ValUatlOn,
hereby affirm that I am exempt from the Contractor's. License Law for the following
d ' 'P
8
.reason: (Sec, 7031;5,Business and Professions Code:._Any city cT,county,which requires a '.
'3+ .
permit to construct, atter, improve, demolish, or repair any structure, prior to *its issuance .also-
requues.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-
'Division'3 of the.'Business and Professions Code, or that. he is'ekempt therefrom, and the basis
/orthe Any Section 7031:5.by'any —applicant for
Plan Chk. Dep.
'
alleged exemption. violation of, permit
•- --'subjects the applicant to"a civil penalty ofnot'more than five hundred dollars ($500)..-
Plan Chk. 811.
" .0 I, as owner of the property, or my employees, with wages as their sole: compensation, will
Co the work, and tfie structure is not intended or offered for sale. (Sec. .7044,Buisness and
Const.;
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.quch Improvements are not.intended or .offered for sale. If„ however,'the building -
or improvement is sold within one year o/ completion, the owner -builder will'have the burden.
Electrical
-
of proving that he did not build or improve /or 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 o/ property who builds or. improves thereon, and who contracts for
S:M:L •
_
50
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ' •_ ..
Grading
'
❑ 1 am exempt. under Sec... B. & P.C. for this reason
Driveway Enc.
_ Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm 'that I have a certificate of consent to -self -insure, of 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.. ❑ Certified copy is hereby furnished'.. .
TOTAL
CERTIFICATE OF EXEMPTION FROM
REMARKS'
WORKERS' COMPENSATION INSURANCE .. J. .
(This section need not be completed i/ the permit is for one hundred dollars' ($100) valuation •
..or less.) .. ..
certifyAhal in the performance of thg work for which this permit is issued, i shall not{1*;}'rti'�
,y1;''•', i- Ktix �1.; 1 "• h :.-• _ 4
employ any -person in -any manner so as to become subject, to the Workers' Compensation '
3 A 4-9%tfi L f V r Nf_ Y r L . V-si
Laws of California.
'Date ' Owner '
NOTICE TO APPLICANT: I/, after making thisCertificate of Exemption • you should, become
ZONE:
- BY: "
' subject to the "Workers' Compensation provisions -o/'the Labor Code, you must forth With
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 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-
FINAL 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 read this application and state that the.above Information is correct."
-all 'to
ISSUed by,
Date Ag�,Permit
agree to comply with city and county'ordinances and state laws relating 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 FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT. p
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. 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 APP.IEQUIP.
LAUNDRYTRAY
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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
r
_
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.
L/tREINF. STEEL �— 8
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
?f,tBOND BEAM — / ��
6
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. _
FRAMING
FINAL INSP.
ROOFING
r
_
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