002989 (BLCK)r" P.O. BOX 1504
Building 78-105 CALLE ESTADO
Addres 52-4 4 Avenida F�'ta�c202) LA QUINTA, CALIFORNIA 92253
Owner
Mailing,
Addresses Q. B= 1()16
City Zip
L1 Oui1ta, CA 9225
Contractor
Address.
78-330 CWW Dimiw
La QuiMa. CA
State Lic.
& Classif. 344
I Arch., Engr., '
i Designer
I Address
City Zip State
I. --. . . I I Lic. #
Tel.
. L,VL,��LV VvnI nnVIVnJ YCVL/inM11V1'1 „�; ,_ �
I hereby affirm,that-1 am licensed under provisions of Chapter 9 (commencing with Section
BUILDING: TYPE•CONST. OCC: GRP.
A.P. Number 773-241`-025
Legal Description lat 16
Project Description
3* H#fnaetakwd
7000) of Division 3 of the Business and ProfessionsCode,:and my license is in full force andj
Tel.
,5..407�}
effect
i SIGNATURE - DATE
Tel..
Estimated Valuation
I hereby affirm that I am -exempt from the Contractor's License Law for the following
City
Lic. #
Sq. Ft. t No. No. Dw.
Size Stories - Units '
New ❑ Add O Alter ❑' Repair ❑ Demolition ❑
Tel.
. L,VL,��LV VvnI nnVIVnJ YCVL/inM11V1'1 „�; ,_ �
I hereby affirm,that-1 am licensed under provisions of Chapter 9 (commencing with Section
'
7000) of Division 3 of the Business and ProfessionsCode,:and my license is in full force andj
,
effect
i SIGNATURE - DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
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
'to
"i
permit construct, alter, improve, demolish, of 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
I 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 7031.5by any applicant for a. permit
Plan Chk. Dep-.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
-
Plan Chk. Bal.
❑.l, 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
Const.
Code: The Contractor's License Law._ does not apply to an owner of 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 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.I.
- - such projects with a contractor(s)-licensed pursuant to the Contractor's License Law.) -
-
Grading
❑ I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Infrastructure
. Date owner
WORKERS' COMPENSATION DECLARATION
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
❑ Copy is filed with the city. ❑ Certified copy is hereby.furnished.
CERTIFICATE OF EXEMPTION FROM
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 the work for which this permit is issued, I shall not
employ any persona 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 to the Workers' Compensation , provisions of the Labor Code, you must - forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I 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.)
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.
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.
Signature of applicant Date
Mailing Address
City, State, Zip
TOTAL
REMARKS
AMOUNT
25.07
ZONE: . BY:
Minimum Setback Distances:
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 311-AMPermit
Validated by:
Validation:
A7523 3 13 64.62 it
HARD COPT
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
I` -
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS'
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CARP. SO. FT. ®
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN
SO. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
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 APP./EOUIP.
REINF. STEEL 3 �7--/j;g
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 SIGNATURES/INITIALS,
GARDEN WALL FINAL