003151 (BLCK)Building
Address«.��
Owner
Mailing
Address
City
T:,a iSxavtinp t4
Contractor
...Aaaress ..
P.O. BOX 1504 No. ,,003151
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST: OCC: GRP.,
A.P. Number T7'k..1kS2�9
Zip Tel. Legal Description
Project Description 65t of If 'Rafth a g.0
City
Zip ..
Tel:.
State Lic.
City
& Classif."..
Lic. #
Sq. Ft.'
No. No. Dw.
Size
Stories -Units '
' Arch.; Engr., ... .. ... .. _..
Designer
New ❑ Add b
Alter ❑ • Repair ❑ -Demolition ❑.
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
7000) Division
of 3 of the Business and Professions Code, and my license is in full force and
effect
SIGNATURE DATE
,.,,._ - ,•_ -, •
~
OWNER -BUILDER DECLARATION -
Estimated Valuation
I hereby affirm that I ani exempt from.the Contractor's License 'Law for the following41
'740 '�
reason:.(Sec. 7031.5,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
-
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
_ Division'3'of the Business and*Piofessions Code, of that, he -Is-ezempt.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 five hundred dollars ($500). • . "'- '..
Plan Chk. Bal.
1 A
O I; as owner of the property, or my employees with wages as their sole compensalion,.will•�;
do the work; and the structure is not intended or offered for sale. (Sec. •7044, Buisness and .
{,CiOrlst.i%3.
_�"
-Professions Code: The Contractor's License Law does 'not apply..to an owner of property who
builds 0,improves thereon and who does such work himself or through his own employees,
'Hoch.'
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
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, Business and Professions Code: The Contractor's License Law
does not, apply, to an owner of property who builds or improves thereon, and who contracrs for
'S.M.I.
- such projects with a contractor(s) licensed pursuant to the Contractor's License -Law.)
Grading
❑.Lam exempt under Sec. B. t> P.C..forthis•reason
Driveway Enc.
' '' ,+
Date ' .rte x Owner .s..a@,R' M•.� n. .,,n ,� .� ,.,cr
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.)
Policy No. .. - Company
• .O Copy is filed with the city.. ❑.Certified copy. is hereby furnished. ,
TOTAL
CERTIFICATE OF EXEMPTION FROM
` REMARKS
`
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is- for one hundred -dollars ($100)' valuation
t �s r�
005182,.,� 0 - 5,50+�+''r 06••^11-94 _A2
. or•less.). .. - . .. .. ... ..
certify that in the performance of thg work for which this permit is issued;.I shall not
n
Jti V• 'u i'96Y f; i }'} 1 i^te.
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date' Owner '
•BY:
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 SetbacKDista
Front Setback from Center..Line
Rear Setback from Rear.Prop. Line
CONSTRUCTION LENDING AGENCY-
Side'Street Setback from Center. Line
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 Setback from Property.Line
Lender's 'Name
_ Lender's. Address
':
FINAL DATE ' '
INSPECTOR -
This is a buildingpermit when properly filled out, signed and validated, and -is subject to
expiration it work thereunder is suspended for 180 days:
. I certify that I have read -this application and state that the above information is correct.
'
Issued by:
-Date +h4 �"� Permit-
I'agree to comply with all city and county ordinances and state laws ielating to building':
a
construction, and hereby authorize representatives ',of this city to -enter the abcve-:'
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,-
1ST FL. SQ. FT. @ $
2ND FL. SQ. FT.
POR. SO. FT. @
GAR. SO. FT. @
CARP. ,SQ. Ff.
WALL SQ. FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
I ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAS (ROUGH)
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.
SQ. FT. @ c
BATH IUB
WATER HEATER
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
BOND BEAM
SO.FT.GAR @ 3/ac
HOUSE SEWER
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
1
//v(FOUND. REINF. —'f/ _
L10
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
C
.......... ®��
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL`..
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL _
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL