002728 (INST)_ate.GGIry
P.O. BOX 1504 No.
Buildingra.,3f 2+"'$'i3arii .. 78-105 CALLE ESTADO
Address' LA QUINTA, CALIFORNIA 92253
Owner.. .._.. ... .. ....: .. .. ..... ..
Mailing
BUILDING:-TYPE•CONST. OCC: GRP: •
Address, A.P. Number
City Zip Tel.
A_64�'--2.2�i Legal Description
Contractor Project Description
£=" +.iCAw31N. r
Address _-Mastall T:33nace. -£s.nd Rrs.'3- 11m i -c le
..City .. - Zip ... Tel:...
State Lic. City
& Classif. , . Lic. # Sq. Ft. No. No. Dw.
Stories i
Arch.; Engr., :. .... Size - ... ries Units
Designer New ❑v.• Add ❑- Alter ❑ ._ Repair ❑. Demolition ❑
Address Tel.
City Zip State
..... _ . '.. -. . ... , Lic..# ..
LICENSED CONTRACTOR'S DECLARATION '
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 1s 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 1` v'SVtiS/sViP
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, alsorequires -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, Chapter9 (commencing. with Section 7000) of. ss '
Division 3 of the Business and. Professions Code,' or that. he'is exempt therefrom, and the basis _ -
for the alleged exemption. Any violation or Section � 703.1.5 by•'any applicant .for. a permit ..Plan •Chk. Dep.
'subjects the applicant to a civil penalty of not more than five hundred'dollars ($500):' - - i . • ' Plan Chk• Bal.
❑ I, as owner of the properly, 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
Professions'Code: The Contractor's License Law does not apply to art.-owner,of property who- Const., ¢
builds or improves thereon and who. does such work -himself or through his own.employees, Mech. • 1"4. f , �5
'provided that' such improvements are not intended.or offered' for sale. If, however, the building
or improvement is sold within one year of completion,- theowner-builder will have- the burden Electrical '
of proving, that he did not build or,improve for the purpose or sale.)
:O I, as owner of the property, am exclusively contracting, with licensed contractors to con- Plumbing 1.00
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 S. M. 1. ' ' .50
such projects with a confractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. - B..& P.C..foathis reason -t Grading
r , Driveway Enc.
Date Owner -.-�� r, .*'�` 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
❑ Copy is filed with the city.. Q Certified copy is hereby furnished. -
TOTAL 33.50
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.) .. ... . _ - ... ..
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: 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
„MIr1lrnUnlSetbaCkDISt8f1C8S: -
comply with such provisions or this permit shall be deemed revoked. - - -
F.,ront.Setback from Center Line
Rear Setback from Rear. Prop.. Line
• CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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
This is a building permit when properly filled out, signed and validated; and is subject to FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 180 days.C�'y�
I certify that I have -read this application and state that the above information is correct: - Issued by: Date Permit
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.
bove"
mentioned property for inspection purposes. Validated by:
. � .. ..
Signature of applicant %h �_ Date
Mailing Address ,fe _ . Validation:.
City, State, Zip .f
A 6 8 1 6 11 24: 8-5L Lk
HARD COPY T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. 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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
vl/GAS (ROUGH) l
rGAS
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.
SQ. FT. ®c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
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
ROCKSTORAGE
FOUND. REINF.
vl/GAS (ROUGH) l
rGAS
METER LOOP
TING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
(FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
61NAL INSP. /
l
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL