002971 (SIGN)44a
t�GG+fCV
P.O. BOX 1504 No. 002971
Building78-105 CALLE ESTADO
7
Address Rr9""259 Pred itwiM-Drive LA QUINTA, CALIFORNIA 92253
Owner
Pw ftmxiam rAnd D� Co' BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address 187 11. t3�amet 10E!C.►"�? �, A.P. Number AR
City Zjp Tel.
Pizloentla 926(i14)99r-20 Legal Description --- ---
Contractor Project DescriptionBE.' ^�
Pz=isim 1
Address -
F. d. B= 3938
City _ r
ip - Tela .
Falco ,� C.92261 341-0411
State Lic. City
& Classif. 472843 Lic. # 931. Sq. -Ft. No. No. Dw.
Arch.,'Engr.,- .
Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel. Y
City Zip State
Lic. # - -
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 �.
effect. f
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
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also r
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 and Professions Code, or that. he is exempt therefrom, and the basis plan Chk. De -
I ' for the alleged exemption. Any violation of Section 7031.5 by 'any applicant' for a permit p -
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). " -
. PIan.Chk. Bal.
❑ I, 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 COr1St. a� ryn,/� nn
Professions Code: The Contractor's License Law does not apply to an owner. of property who •W 20.(M
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 Mech: 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.),
❑ .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
O I am exempt under Sec.. B. & P.C. for this reason
Driveway Enc.
Dale 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. ' Company
CrCopy is filed with the city. O Certified copy is hereby furnished. y rF_7
Sff TOTAL .�i+' 20.50
CERTIFICATE OF EXEMPTION FROM REMARKS
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 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 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 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 FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 180 days.
%!/� permit
I certify that I have read this application and state that the above information is correct. Issued by: Date
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 inspection purposes. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
A 7 b 1 0 3 27 1 5 ll
HARD COPY
T '
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
FOR. 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 SD. Ff.
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
WASH ER(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.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.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.IEQUIP.
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
�
DEC
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL