003313 (BLCK)'414 _
P.O. BOX 1504 No.�' .
-Building 78-105 CALLE ESTADO
Address 51-780 V,1 LA QUINTA, CALIFORNIA 92253
Owner
MOOR DMING
MaiIin BUILDING:, TYPE CONST. OCC:GRP...:-
Address 51-780 MUy�}y t� + MLA A.P. Number 773-133-023 .
City Zip Tel.
L, . +14 TA 9223 ... 56-412E33. Legal Description
Contractor Project Description M—jF'LAVI .: WADS
Address .
City Zip Tela
State Lic.
City
& Classif...
Lic. #
Sq. Ft.. ',
No. No. Dw.
Size,
Stories Units
Arch., Engr.;.... _.. ... _
Designer
New ❑ Add ❑
Alter ❑..' Repair ❑ ' Demolition ❑
Address
Tel.
City
Zip
State
Lic: #
LICENSED CONTRACTOR'S DECLARATION '
I hereby affirm that am'licensed under provisions'of Chapter 9 (commencing'with Section
7000) of Division 3 of the Business and Professions Code, and my licens"e'is in full force and
• effect....
SIGNATURE DATE
•,
_ ,- .
OWNER -BUILDER DECLARATION
Estimated VdlUatlOn
I hereby affirm that I am exempt from the Contractor's. License Law for the following
• reason; .(Sec. 7031.5,13usiness and Professions. Code: Any city or county -which requires •a
'permit
to constiuct; alter, Improve, demolish, _or repair any structure, prior to its issuance also
requires the applicant for such permit to. file a signed statement lhaPhe is licensed pursuant: to
, s -,PERMIT -
- - AMOUNT -
the provisions of the Contractor's License Law, Chapter 9 •(commencing with Section 7000) of
-
Division 3 of the Business and Profes"sio`ns 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 •
Plan Chk. Dep.
- -
• -subjects the applicant to -a civil penalty of not 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
do the work, and the structure is not intended or offered for sale. (Sec.:7044, Buisness'and
Const.
t� r�
Professions Code: The .Contractor's License Law does not apply to an owner of property who
2:.0.0�J ,
builds or improves thereon and who does such work himself or through -his own employees,
Medh.
provided that'such improvements are not intended or'_oflered for sale..q, 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
slruct 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 contracts for
S.M.I. '
- '•
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
. ❑ I am exempt under Sec. B. 8 P.C. for this reason -
;.)
Driveway Enc.
Date •.f^ x ' owner -
Infrastructure
WORKERS' COMPENSATION DECLARATION
' I.hereby affirm that I' have a' certificate 'of consent.to selfinsure, or 'a certificate`of.'
a
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
- ^
. or less.) .. .. .. _ .. .. ..
I certify that in the performance of thg work for which this permit'is issued, t shall not
employ any person in any,manner so as to become subject to the Workers' -Compensation'
Laws of California.
iW i,St,JtY
Date!_.' Owner
NOTICE TO APPLICANT: 8,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 iea 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..
'city
Issued by:
'Date f+9`A2 Permlt
f agree to comply with all 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 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. SO. FT. ® $
2ND FL. S0. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. SO. FT.
WALL SO. FT. ®
SO. 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
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SEWER OR SEPTIC TANK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. 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
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
I SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
+
i
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTORft
GAR. FIREWALL
LATHING e7
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL