003576 (BLCK)P.O. BOX 1504 No. 003576
Building 78-105 CALLE ESTADO
Address 78-1.79 Hacienda LA QUINTA, CALIFORNIA 92253
OwnerBob .
LlL3h3d BUILDING: TYPE CONST. • OCC: GRP.
Mailing
Address ;nom A.P. Number TA Qulmta CO3 ntr,,,T Club
City Zip Tel.
��.. 6�� Legal Description
oninta 92ContractorProject Description 61 X 60, Rlock Mall
To • AA' Kennedy '
Address
77-350 Arroba
City - zip-
T.n
ti 1,
State Lic. City
& Classif. 442119 Lic. # .Sq. Ft. No. No. Dw.
Arch., Engr., - . - -
Size - • Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State 7771
Lic. # _
LICENSED CONTRACTOR'SDECLARATION
I hereby effirm.that.l am licensed, under provisions of Chapter 9•(commencing with. Section
7(100) of Division 3 of the Business and Professions Code, and my license is in full force and
effect. - - - • - -
'REMARKS
_ SIGNATURE _ DATE
OWNER -BUILDER DECLARATION
I hereby affirm that l am exempt, from the Contractor's License Lew for1he following
reason; (Sec. 7031.S,Busiriess and Pro/esslorts Code: Any city -or county which, r Iree..a�
perrrift toconstruct, attei, hnpiove,_ demogsh, or repair any structure, prior to itsisauence-alao
the .app/trent tor. suchperrrix to tile: a a/gstatementtheIslicensed pursuant ro
o/
3 of tAe Ltrlsmess-and Prolesaions Code;or that. he !s exempt•fherelrom; 'and thebaslse- alleged exemption. Any violation o/ Sectloa 2.031.5 'Dy 'any epplkant foi a permtt
Eb,.appOcant ro a cid/penatty'o/.1 more than Bve'hundied dol lais'(5500).-""'-
❑ I; as owner of the property, or; my employees with wages as their sole compensation, will
_
Estimated ValUatlOn
- -
- PERMITv/s/onContracrorLicenseCapt9commencingw1tASection7000)
Plan.Chi. Dep.ts-the
Plan Chk. Bal.
COrISt.
- ..
do the work, and the structure ie not intended or offered for sale. (Sec. 7044, Buisness and '
Professions Code; The Contractor's License Law does not apply to an owner -ofproperty.who
builds or'snproves thereon and -who- does such work himself or through his own employees,
.provided that. such improvements .are not intended. or offered /or safe. ll. -however,, the building
or improvement is sold within one year of completion, .the owner-bulkler will have the burden
of prodngahat he did not build or bnprove for the purpose of sale:)'
Mech.
' Electrical
Plumbing
O l; as owner of the property, am exclusiyely 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 ownerof property who builds or improves thereon, and who contracts for
- S.W.
-
- such proJetts with a contractor(s) licensed pursuant to.the Contractors License. Law.) - -
r.
❑ 1 am exempt under Sec. B. & P.C. for this reason
r
Grading
Driveway Enc.
Data I- ,owner -'' yrrr
Infrastructure
Minimum'Setback Distances: '
WORKERS' COMPENSATION DECLARATION,."'
I, hereby affirm that'd have a certificate of consent to self -insure, or a:certiflcate of
Worker's; Compensation Insurance, ore certified copy thereot. (Sec. 3800, Labor Code.)
Policy NO. Company
Rear Setback from Rear Prop. Line
❑' Copy Is filed.with,the city. ❑ Certified copy is hereby furnished. ..
TOTAL
I hereby affirm that there, Is a construction lending- agency for the: performance of the
AMOUNT
X6 50
-n
CERTIFICATE OF EXEMPTION FROM
'REMARKS
WORKERS' COMPENSATION' INSURANCE
(This section need not be completed it the permi Is ,for one hundred dollars ($100) .valuation
-
or less:) - .. .. _
I certify that in the performance of the work for which this permit is Issued, 1 shall not
; _ •_ - .._
=any person•in anyrnanner so; is.to'become subject to the Workers' Compensation
Laws'of California
- • -- - - - - - -
Date - Owner'
NOTICE TO .APPLICANT, ff, after making this Certificate of Exemption:,you should become
-
:ZONE:
BY: W
subjectto the Workers' Compensation provisions of the LaWr Codes you -must forthwith
comply with such provisions or this permit shall be deemed revoked- -
Minimum'Setback Distances: '
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'forwhlcn this Permit is issued. (Sec. 3097, Civil Code.);
Side Setback from Property Line
Lender's. -Name
Lenders 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 Ihave, read this; application -and state that, the above Information As. correct.
-state
ISSued':!by:'
Date Permit
I agree to complywith All -city and county ordinances and laws relating to building
construction, and hereby authorize representatives -of this city to enter the above
mentioned property for Inspection purposes.
Validated by-
Signatur&of applicant Date
Mallinq Address
Validation:
City, State, Zip
HARD COPY
CONSTRUCTIONESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS.
COLL. AREA
2ND FL. SQ. FT.
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
ROUGH WIRING
DUCT WORK
DRAINAGE PIPING
CAR. P. SQ. FT. ®
GAS (ROUGH)
WALL SO. FT. ®
HEATING (FINAL)
DRINKING FOUNTAIN
SQ FT @
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER.
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
cu. yd.
$ plus x$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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
FIRE ZONE ROOFING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1V4 c
SEWAGE DISPOSAL
SPARK ARRESTOR
SQ.FT.GAR ® 3Ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMITTEE
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.
/I&ZFOUND. REINF. 2_ / _
v
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
ND BEAM —
j'
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