002589 (BLCK)44
' l P.O. BOX -1504 N o .
Building -52-530 Avemi-da. VLUa78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
ra.3 lmxb
Mailing
Address 7 00achalla Heic-fts
City Zip Tel.
. vbeicW. . 922 - -3"-5191-
Contractor 3"-5191.
Contractor
Address
State Lic.
& Classif.
IZiD .. ._ . ITel. '
City
Lic. #
BUILDING TYPE CONST.• • OCC: GRP.-
A.P. Number 773-3042
Legal Description lot 22 '
Project Description
Sq. Ft.. No. No. Dw.
Size ..140 lin. ffStories Units
Arch., Engr..
Designer :
New•[ft Add ❑
Alter ❑. Repair ❑., : Demolition ❑
Address
Tel.
_
AC ! k iftniniM 1' .
City
Zip
State
.. ... . .
. . -
Lic. #•
LICENSED CONTRACTOR'S DECLARATION
v
71 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
hereby affirm that I am exempt from the Contractor's License Law for: the following,$28,100.00.
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.Cand ProfesslorW Code, or that.he 'is -exempt therefrom,` and the Basis
- ••
_
-
for the alleged exemption. Any violation of Section 7031.5. by 'any applicant fora permit
- Plan Chk. Dep.
• subjects the applicant to a civil penalty of not more than five hundred dollars ($500):'
Plan Chk. Bal_
p'i _
-iy
❑ 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
Corisf. i
Professions Code: The Contractor's_ License Law does. not apply to an ownerof property who.
.50.
builds or improves thereon and who does such work .himself or through his own employees,
' Medh.
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 contracts for.
S.M.L.
such projects with a contractor(s) licensed pursuant to the Contractor's•License Law.) -
Grading
IJ 1 am exempt under Sec. -B: & P.C. for this reason -
�
Driveway Enc.
Date Owner')
Infrastructure
' WORKERS' COMPENSATION DECLARATION
Thereby 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
q Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
6.02
CERTIFICATE OF EXEMPTION FROM
REMARKS
`
WORKERS' COMPENSATION INSURANCE ...
+R
(This section need not be completed if thepermit is for 'one hundred dollars ($100) valuation
- - -
,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.
_._.Date Owner
'
NOTICE TO APPLICANT: If, after making this Certificate of. Exemption you should become
-'-subject
ZONE: -
BY:'
to the Workers' Compensation provisions of the 'Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
_
Minimum Distances: - -
Front. Setback from Center..Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY w
Side Street Setback -from.Center Line
I hereby affirm that itiere 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 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 Ahe above information is'correct: .
I 'county
Issued by-
Date Permit
agree to comply with all city and 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 t\
Validation:
City, State, Zip
#
A 6 4 0 4
9 29 64,t 2 CK
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEEN
IST FL. SO. FT. (off $
2ND FL. SQ. FT. ®
POR. SO. Ff. ®
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
I ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUMB.
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
GAS (ROUGH)
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
EL4OND BEAM �G�, • S
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
ROOFING
GAS PIPING
PERMIT FEE
REMARKS:
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
D PLUM G
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE /Y
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
% ORMS �Z/ Z
r
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
OUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL / 7
GAS (FINAL)MP.
POLE j Z� f7
v
GROUTor
WATER HEATER
SERVICE
FINAL INSP.
EL4OND BEAM �G�, • S
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
=$
LUMBER GR.
FINAL INSP. %
FRAMING
FINAL INSP.
ROOFING
DECINSULATION/SOUND D 17 3�Lf
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL