04824 (BLCK)P.O. BOX 1504:
Building 78-105 CALLE ESTADO `
Address ' .52-530 VillaLA„QUINTA CALIFORNIA 92253.
...
Owner
-Javier Lorene
Mailing BUILDING: TYPE CONST. OCC. GRP.'
,�. ,
Address
+a13 A.P. Number 11,3"'4""00
City Zip Tel.
La Ouinta 92253 Legal Description
Contractor Project Description 109' r .31 high +fall
Address ,
City. Zip Tel.
State Lic: ; City
& Classif. ' - Lic. # Sq. Ft. No. No. bw.
Arch., Engr.,: ,�' Size ',Stories Units
Designer r « New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address, Tel.
- ca. • I
City Zip State
Lic. #
t 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 i
effect.
:!SIGNATURE - DATE -
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the followingJ2 4 "
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requGes a ' •k•
permit to construct; alter, , improve, demolish, or repair any structure, prior to Its issuance also-
arequires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT AMOUNT�a'"'
• the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
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 Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars (8500). �4 '
❑ I, as owner of the property, or my employees with wages as their sole compensation, will �.. Plan Chk. Bal.
' 'i do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
Professions Code: The Contractor's License Law does not apply Ito an owner of property who '
+builds or improves thereon and who does suchworkhimself or through his own employees. Mech.-
,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 _ r -
• 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 fD
does not apply to an. owner of property who builds or improves thereon, and who contracts for S.M.I. t•.,gpgr, ,
such projects with a contractors) licensed pursuant to the Contractor's License Law.) '
Grading , f
O 1 am exempt under Sec. ' B. 8 P.C. for this reason
Driveway Enc. ^ .
Date of A'Owner.
ti•' InfrastructureG r+,
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.) r
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL .. t
T ..
'CERTIFICATE OF EXEMPTION FROM REMARKS t k,�.,.�,,.e .nrf; a 1k if*4 ? A 4 :.d. 7606 '. +' ' 4
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.) -
I certify that in the performance of thg work for which this permit isissued, I shall not ,
employ any person in any manner so as to become subject to the Workers' .Compensation
Laws of California. - 1
Date -
,.a NOTICE. TO APPLICANT: 'if, after making this Certificate .of Exemption you should become.- ,1 ZONE: ' BY` -
* subject to the. workers” Compensation provisions of,Ike Labor, Code, you. must forthwith
comply with such provisionsor this permit b
Minimum Setback Distances:.
. s persae deemed'revoked.. - i'.
h °7
LL—Firbint Setback from Center Line
.-•. Rear,Setback from Rear Prop Line
CONSTRUCTION LENDING AGENCY., `? Side Street Setback from'Center Line -
I hereby 'afhrm that there is a construction lending agency for the performance oCthe •:
.., work for which•thls permit is' issued. (Sec. 3097;'Cldl Code.) - -' • ' - Sltje Setback from Property Llne
• 'Lender's Name + , ; }
Lender's "'Address
r - - �•'FINAL DATE INSPECTOR t '
• •> This is a building permit when properly filled out, signed and validated and is subject to p yl tYti
expiration it work thereunderis suspended for 180 days. r ' f•' 7 J4 +r
' 'I certify that'I have'read.this application and state that the'abo've information is correct,'. Issued by Date ` Permit•
' I agree to comply with all city and county ordinances and state laws relating to building e,
construction,' and .hereby authorize representatives', -of this city to .enter the above.. ^• 2 k`
t mentioned property for inspection purposes.' y Validated by
Signature of applicant p y Date
,r -•.Mailing Address -'k - ` Validation:;
1
� i Clty ,Stale ,Zip J r -• � ' w t 'r � w � �• �jw n ' i'j' ir, `� � •
_,r-� 4 ',,1 � ��... .. ^ n w ''.!�. +a ..;.d`• .:- v. � � yF_-ar ¢. .�5 a �;�'�, �: .t' � ,'""�. � c; -',
WHITE FINANCE PINK$ APPLICANT GREEN.. BUILDING, GOLD,ENROD.' ASSESSORS OFFICE HARD COPY'- FILE,,
•y. <<.s!y _,_s4u,^.;....��_�•. Tie;:....._:»,3',t"�:n.>_s%w. c_,rr..x., ,..t. .t_..C.f:I_. �.f� a',L:»'tv,_.,:r'� 'irrir'!'r-.t!:,. a'..✓n:l ate. rf,x�ttk,r.:-.l_.,r:,_L ..kr.� .._k:..e �..:4 ...-'.2?.i�S4ig.:J_;:.n+ ,-.,�._:. .r. .a.. •. x..+1"1
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT y S
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. R
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT. a
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. 6
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT. i�
FINAL INSP.
I
WALL SO. FT. rd
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu. yd.
$ plus x$
=$
URINAL
SO. FT. 0
FINAL INSP.
FRAMING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTONDISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
LAUNDRYTRAY
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 @ t V. c
SEWAGE DISPOSAL
SO.FT.GAR rg >/.c
HOUSE SEWER
FINAL INSPECTION
GAS PIPING
PERM17 FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE bL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 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 APP.IEOUIP.
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 SIGNATURESlINITIALS
GARDEN WALL FINAL