10960 (BLCK)Building 52-•^20.1 Villa
Address
Owner
Mailing
Address same a5 above
VA Quinta zip 32253
r
�B+u3.1der
ty
Zip
P.O. BOX 1504 // _ �¢— No. 10960
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253 tt
BUILDING: TYPE CONST. OCC. GRP.
Tel. 564-4246
P. Number
Legal Description
Project Description
of 6 y block wall
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 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. ,
SIGNATURE DATE
_
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
2 ���
. reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
/
permit to construct, after, improve, demolish, or repair any structure, prior. to its issuance also
-
-- '
requires the applicant for such permit to rile a signed statement that he is.licensedpursuant to
PERMIT
AMOUNT
the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) o/
Division 3 o/ the Business and Professions Code, or that. he is 'exempt therefrom, and the basis
for the Any Section 7031.5 by 'any for
PIan.Chk. Dep.
alleged exemption. violation of applicant a permit
�subjects the applicant to a civil penalty of not more than five hundred dollars.($500).
Kr
Plan Chk. Bal.
1,'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
CiorlSt.
$ J �}
Professions Code: The Contractor's License • Law does not apply to an owner or property who
builds or improves thereon and who does such work himself. or through his own employees,
Mech.
provided that such improvements are not intended or offered for sale. If, .however, the budding ,
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 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 notapplyto an owner of property. who builds or improves thereon, and who contracts for
S.W.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
.20
Grading
O I am exempt under B. 8 P.C. for this reason
Driveway Enc.
Date owners ` ' -
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
43.20
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
This section need not be completed if the
( P permit is for one hundred dollars ($f00) valuation
tt�� �r�• +7 �� f; �'•' ��t
T
I certify that in the performance of thg 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.
'
Date Owner
NOTICE TO APPLICANT:ff, after making this Certificate o/ Exemption you should become
ZONE:
BY:
' subject to the Workers' Compensation provislons'o/the Labor Code, you must -/ormwitn
comply with such provisions or this permit shall be deemed revoked. •
Minimum Distances: -
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.)
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 agree to comply with' all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. @
GAR. SO. FT. ®
CAR P. 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® V4c
HOUSE SEWER
FRAMING
FINAL INSP.
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
SERVICE
FINAL INSP.
BOND BEAM
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL