003363 (RPL)Building S:& 78-1l�,� 19
Address L i {1
Owner
DR, ALS I
Mailing
Address SAME
City Zip
Contractor
Address
67-712 f,°
City Zip
►`a 1d' ' i l
State Lic.
& Classif. 185102
Arch., Engr.;
Designer
Address
City '` , Zip
LICENSED COJ
1 herebv affix that. la licensed unit
4
P:O. BOX 1504 No. 003363
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
I el.
affL 4 323-7303
City
Lic.# 7c�__
-1 LIG'..9 -
DECLARATION
:If_Chapter 9 (commencing •wit
:ode;'and;my license is I,?JI
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 617-560'-009
Legal Description
Project Description—�
Sts. Ft. No: No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ ' - Repair ❑ . -Demolition ❑
vwn BUILUEK USCI ARATION -
I hereby affirm that I am axe pt•from t11e Contractor's License lbw for the following
reason: (Sec. - 7031-S,Business ;ar�d Pro/eashxrs. Code: Arty cpy o{ county -;which, requites a
sit to oonstruct, alter, iinpruve, demWLsh, or repadr any structure, pdo/ to .Ifs Issuance also
requ/res-the applicant. for. such: permfl to tile. a sl9ned statement that he /s :Ikensed pursuant to
the' pro"IV 11s of the Contractor's License Law, Chapter;9' (commencing .with Section 7000) o/
Estimated Valuation
• • , �� -
��• 0 (Y,.=Ls
-. -
..PERMIT
- •:• -
- AMOUNT
11'.1or 3 of the Business: end=Piolessons Code, or that he k exempt thereiron, and the basis
for the alleged exemption.. Any vlo/atbn or Sector 7091.5 Dy, 'any app9cant fora permit
subjects "a applicant to a.,W Panatty o/not more than Nva hundred dollare'(S500J:
❑ I, as owner of the property,: or my. employees with wages as their sole ,compensation, will
.-.Plan Chk. Dep.,
Plan -Citi.. Bal:.
GOtISt.
Lt' -r-
1 r
s�-•
-do the work; and the structure is not Intended oroffered'foi sale: (Sec. 7044, Buisness and
Professions Code: The Contractor's license ,Law does not appy- to. an owner o/ property who
builds 6r Improv" thereon 'and: who does such work himself or through his. own employees,
• provided that such improvements are,notIntended. or offered for safe. lf, however,. the "building
-
Mech'.
,# -
Electrical.
? t ,
orimprovement is sold withki one year of completion, the owner -builder will have the burden•'
,. of proving,that he did not buildor Improve. for the purpose of safe.)
Plumbing
n -
El l,: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 Dense Law.,
does not to .an owner; of property who builds or lriproveswtheraw, and who contracts for,
S.M.I.
-
such projects w/ih!a contactors) licensedpursuant to the Contractor's License Law.) - ..
❑ I am exempt under Seca B. 11< P.C. for this reason
Grading
Driveway Enc.
Date owner
Infrastructure.
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 'I'have a'certificate,"of consent toself•insure, or a* certificate of
Workers Compensation Insurance,.or a certified copy thereof. (Sec. 3800,,Labor Code.)
Policy No. Company
filed with the cit
.O, Copy,is,y. ❑ Certified copy is hereby furnished.
TOTAL
q
REMARKS-
_
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N the permit Is for one hundred dollars ($100) 'valuation _
or less.) ... - - _ ..
certify that- In the, performance of thg work for which this'permit is issued, I shall -not
employ any pperson in any manner so as to become subject to the Workers' Compensation
Laws of Gallfornf
„,r .,,; , , .. _
„
uEa.
Date ' Owner -
NOTICE TO APPLICANTN, alter making this Certificate of Exemption you should become.
bor
' subject to the Workers' Compensation provisions of the La. Code, ' you - must forthwith •
comply with such provisionsor this permit shall bedeemedrevoked.
ZONE: BY.;
- -
Minimum. Setback Distances:
Front. Setback from Center. Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY -
1 hereby affirm'that there is a construction )enAing agency for the:perfortnance of the
work for which this permit is issued. (Sec, 3097. Civil Code.)
Side Street Setback from Center Line,
Side. Setback from Property, Line
Lender's Name
Lenders. Address
This is'a building permit when properly filled out, signed and validated, and is subject to
ezpiretion`if work thereunder 1.!suspended for 180 days.
I car itty that I haveread this application and state that the above -information is correct.
1 -agree to comply with all clty'and county ordinances and state laws -relating to building
construction,, and hereby authorize representatives of this city to enter the above-
mentioned properly for Inspection purposes.
FINAL DATE
Issued by:
Validated by:
INSPECTOR -
Date r tT, r �k7PQrrnit
Signature of,applicant Date
Malli ng, Address
Validation:
City, State, Zlp
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT. @'
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. @.
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO., FT. ®-
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SO. FT. ®.
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER„PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP..
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
Q�1
®C P 7 '57
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.
SO. FT. ® c
BATH TUB
SO. FT. a c.
WATER HEATER
MAX. HEATER OUTPUT, B:T.U.
SO. FT. RESID'0 1114 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR.® 314c
HOUSE SEWER
LATHING
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 APPJEOUIP.
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
Q�1
®C P 7 '57
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIOWSOUND
FINISH GRADING
FINAL INSPECTION
CERT: OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL