002845 (BLCK)Building 53-615 A' rdAa VDIA
Address
Owner
Bill �' t
Mailing'
Address
41-i 7A War—ow—Tr PPMAI
City Zip
4-
P.O. BOX 1504 No. 002845
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
wseoct 32260 34383.
Contractor
Address
City ..... Zip Tel:'
BUILDING: TYPE CONST.- OCG GRP:-
A.P. Number 774-133-'018
Legal Description�1!'
Project Description f - �•� ��
State Lic.City
& Classif:
Ljc. #
Sq. Ft. No. No. Dw.
Size 160 • Stories Units
Arch:,Engr. ...... _ .
Designer.
New 'E:ki, Add .0 Alter O Repair 0 • '.
Demolition 0
Address
Tel.
b.
City,
Zip
State
Lic. #
^
M LICENSED CONTRACTOR'S DECLARATION-, _
I hereby affirm -that I am licensed under provisions of Chapter 9 (commencing' with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
a _ ,_ •.. ,. ..
,,.
SIGNATURE DATE
" OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
• reason: (Sec. 031.5,Business and Professions Code: Any city or county which requires a,
permit to construct, alter, improve, demolish, or repair. any structure, 'prior. to its issuance. also,c
requires the applicant for such permit.to rile 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
Estimated 'Valuation
A -2,640.00 640 0
�' •
- - PERMIT. - -AMOUNT
. 'ss
Plan Chk. Dep.
-
Plan Chk. Bal.... •€�
Const.'-
• ..
do the work, and the structure is not intended or offered for'sale. (Sec. 7044, Buisness.and
Professions Code: The. Contractor's. License Law does not apply. to an owner'of property who
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" •„
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.) , ' • '
Electrical '-' -
Plumbing
. .
0 I, 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 not apply to an owner of property who builds or improves thereon, and who contracts for
. such projects with a contractor(s) licensed pursuant to the. Contractor's License Law.) •- -
0 1 am exempt under. Sec. - B: & P.C. for this reason
S.M.I.
_50
Grading
- -
Driveway Enc.
Date ?tom' 1:5:"fOwner r�+� '?-�• - (rf�. ���' ^-- `' 4
Infrastructure
WORKERS' COMPENSATION DECLARATION
' I hereby affirm that I 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.)
x
Policy No. Company
0 Copy is filed with the city.. ❑ Certified copy is hereby furnished.
TOTAL
64,02
_
CERTIFICATE OF EXEMPTION FROM
. _..WORKERS' COMPENSATION. INSURANCE
(This section need not be completed if the permit is: for one hundred dollars ($100) valuation
or less.) .. .. -. ..
1• 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 Workers' Compensation
Laws of California.
REMARKS .
• 111 -da - imAt ��ts p„ p�
1002792 Vex
..
&-a f to 67 wall.
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.
- ZONE: BY:
Minimum Setback Distances:
_
—'
'
Front Setback from Center,Line
Rear Setback from Rear. Prop. 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.)
Side Street Setback .from Center Line
Side Setback from Property. Line
Lender's Name
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.
I.certify that I have read this application and state that the above information is correct.
'I a210-8
gree to, with all city and county, ordinances and state taws relating to building
construction, and hereby .authorize representatives of• this city to enter the 'above.
mentioned property for inspection purposes.
Signature of applicant '� Tar Date
Mailing Address
FINAL DATE INSPECTOR
��p
ISSUed:by: Date i Permit
- - -
Validated by:
Validation:
A 7 5 2 4 3_ 13 _ _...64,6.2
it
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT.
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBI.LEHOME 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
F R 2�
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.
LAUNDRYTRAY
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:
VENTILATION
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
F R 2�
EWER 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 '7 6
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
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL