002585 (PAT)P.O. BOX 1504 No, 002585
Building 78-105 CALLE ESTADO
Address 79-850 Fiesta Drive LA QUINTA, CALIFORNIA 92253 `
Owner
BUILDING: TYPE -CONST. OCC. GRP.
Mailing
Address
sam A.P. Number
j CityZip Tel.
1A 92253 1 Legal Description
Contractor Project Description
Address. `
us- S'tBC,`y Ct.
City Zip Tel.'
vemide 92507 684 -1686 -.'
State Lic. City
& Classif. 31"7ALic. # , Sq. Ft. $ No. No. Dw.
_ Size • - - Stories• Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑- Repair ❑ Demolition -0
Address Tel. M
City JZip State_
Lic. # - - - -
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm thatA am licensed under provisions of Chapter 9 (commencing with Section y '�
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect... t
SIGNATURE'' / DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation t _
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a $ 8.665.0 '
I permit to construct, alter, Improve, demolish, or repair any...struclure, prior to its issuance also sv
fir,... requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions or 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 penally of not more than five hundred dollars ($500). •
0•1, as owner of the property, or my employees with wages as their sole compensation; will Plan Chk. Bal. 48.42
do the work, and the structure is not intended or offered for sale.' (Sec. 7044, Buisness and Const. 14.5U
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improvesd
thereon anwho 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 or sale.) _
❑ 1, 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.
Date owner 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. I
company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL_
CERTIFICATE OF EXEMPTION FROM REMARKS
r WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
I 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 ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith i Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked.
Front Setback from. Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I hereby affirm that thele 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 the above information is correct. Issued by: Date " Permit
I agree to comply with all city and county ordinances and state laws 'relating to building
construction, and hereby authorize representatives sof this city to enter the above-
mentioned property for inspection purposes. Validated by:
Signature of applicant 1 Date ' I - r ;
Mailing Address Validation:
City, State, Zip
A 6 3 9 8 9 26 i 23.52 CK
HARD COPY
T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUV-BING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
60UGH 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
CAR P. I SQ. FT.
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SO. FT. ®
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FRAMING ,2_I(Go �j
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
REMARKS:
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
I
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
FINISH GRADING
SO.FT.GAR ® 3/.c
HOUSE SEWER
FINAL INSPECTION
GAS PIPING
PERMIT FEE
CERT. OCC.
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
60UGH WIRING%
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ Plus—X$—=$
LUMBER GR.
FINALINSP/6-4
Tel—
FRAMING ,2_I(Go �j
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
i='/AF ST -ft Z> / V
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