07527 (MISC)P.O. BOX 1504 N o .
Building 78-105 CALLE ESTADO
Address 51-780 Ay$. ViIla LA QUINTA, CALIFORNIA 92253
Owner y- .
Vimi'nfa DaVid
Mailing BUILDING: TYPE CONST. OCC: GRP.-
Address —i� A.P. Number 773.3.83-023
City ZipTel.
at QUinta.-,J-'92263 » .564— 050. Legal Description Lot23 & 24
Contractor Project Description has LiM
Owner _ .. _
07527
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•D'ECLARATION
I hereby affirm that I amrl&nsetl under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of.thre'Busines% and Professions Code, and my license is in full force and
effect.
SIGNATURE r Ir DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
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
the provisions.of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Estimated Valuation
PERMIT
_
AMOUNT
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).
0.1, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Dep.
Plan Chk. Bal.
COf1St.,�
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
Electrical
-
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.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
.•it... <
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 contracts for
.such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
' O 1 am exempt under Sec. B. & P.C. for this reason
S.M.I.
��
Grading
Driveway Enc
Date Owner,
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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
0 Copy is filed with the city. ❑ Certified copy is hereby furnished.
�' •" r
TOTAL
15.0 ,�.�':_ (JI i
REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed Y the permit is for one hundred dollars 3100 valuation
r )
or less.)
I 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.
• &t?
sAV4 lifA r i �� i1:5
_... _
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
Ihereby 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
FINAL DATE
INGPECTOR0
/�O
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to/3p
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 purposes.
Issued by:
Validated by:
Date Permit
Signature of applicant Date
Mailing Address
Validation:.
City, State, Zip `
CONSTRUCTION ESTIMATE
. N0. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. '@ $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®,'
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT. ®
4
DRINKING FOUNTAIN.
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
€
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
;
GARBAGE DISPOSAL
FURNACE 'UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
A E
„
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 TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
_ .. SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL L '
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
'
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE t r
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
FINAL INSPECTION -
4
CERT. OCC.
L
FENCE FINAL
STRUCTURE PLUMBING ' • ELECTRICAL' HEATING & AIR COND. SOLAR-
SETBACK
OLAR-
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH) y.
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE '
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL) 1, *
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
r
„
-
'
A E
„
REMARKS:
VENTILATION
w
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL L '
LATHING
MESH
t INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
%a
GARDEN WALL FINAL