001698 (BLDG)Building 79-,630 Fii�d
Address
Mailing
Address .79-830 Aes
City Zip
.. La.Qj
Contractor
Address
City lZip
State Lic.
& Classif.
Arch., Engr.,
Designer
Address
i 4 hf � Qu
P.O. BOX 1504 No. 001698
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Tel.
Legal Description
Project Description Installati= of SateUi= Dish
Tela
I Lic. #
Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
2000) of Division 3 of the Business and Professions Code, and my license is in full force and'
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
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
permit to construct, after, 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
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3'51 the Business and' Professions Code, of that. he 'is' exempt therefrom,and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant. for a permit
subjects the applicant to a'civil penalty of not more than five hundred'dollars ($500).' '
❑ 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
Professions 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,
provided that such Improvements are not intended or offered for sale. If, however, the building
-or,improvemenf is sold within one year of completion, the owner -builder will have the burden .
or 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-
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
such projects with -a contractor(s) licensed pursuant to the Contractor's License Law.)
0.1 am exempt under Sec. B. & P.C. for this reason
Sq. Ft. No. No. Dw.
Size Stories Units
New 2 Add ❑ Alter ❑ ' Repair ❑ Demolition ❑
rrw�
Estimated Valuation 2,00s00
,%Infrastructure
PERMIT- .
'
-• AMOUNT
t
Plan Chk. Dep.
Plan Chk. Bal.3.�ix
WORKERS' COMPENSATION DECLARATION
Const.
-
Mech. '
Policy No. Company
Electrical
Plumbing.
S.M.I.
.ori
Grading
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
Driveway Enc.
Date owner VJ�^4"0 -+"'' "� � �� 'r' ""ra•
,%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
641U2
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed if the permit is for one hundred dollars ($400) valuation
or less.) -
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: If, after making this Certificate of Exemption you 'should become
'subject 'lo the Workers' Compensation' provisions' of the Labor Code, you, must forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY'
Minimum Setback Distances:
Front 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,
expiration it 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 -of this' city to enter the above-
mentioned property for inspectionpurposes..—y yr
Signature of applicant Y M f� .' i� %7 �f .�" ty% y P Daf"e1 )
FINAL DATE
Issued -by:
-Validated by:
INSPECTOR
��
Date3 5 Permit
Mailing Address r Y % : r
City, State, Zip
Validation:
A 2 4 8 4
T
9 3 64,612 R
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
Y
ARD 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. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SQ. FT. ®
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN
SQ. 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, TEMIPERM
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
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./EQUIP.
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 SIGNATURES/INITIALS,
GARDEN WALL FINAL