003759 (RPL)44
P.O. BOX 1504 No. 003759
Building 78-105 CALLE ESTADO
Address 52-654 Herrera LA QUINTA, CALIFORNIA 92253
Owner _
Mailing
Address Sarre
City Zip Tel
La Outnta 92253
Contractor
Address
ty,-
State Lic. lCity
& Classif. Lic. #
Arch., Engr.,
Designer
Address .Tel.
City Zip State -
Lic. #
�- LICENSED CONTRACTOR'S DECLARATION
I 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
II effect.
SIGNATURE - DATE
! OWNER -BUILDER DECLARATION
I I hereby affirm that I am exempt from the Contractor's License Law for the following
1 reason: (Sec.7031.5,Business and Professions Code: Any city or county which requires a ,
-permit io construct,* -alter, improve, demolish, or repair any structure, prior to its issuance also
I requires the applicant for such permit.to file a signed statement that he is licensed pursuant to
I 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
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).
O 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
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 improvement 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.), -
O 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.) -
O 1 am exempt under Sec. . B. & P.C. for this reason
Date + f� '7 Owner
WORKERS' COMPENSATION DECLARATION .
I hereby affirm that I have a certificate of consent to self -insure, or'a ertificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Manor Code.)
Policy'No. - Company
O Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE -
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
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.
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 773-234--!026 '
Legal Description
Project Description Poul
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
comply with such provisions or this permit shall be deemed revoked.
Sq. Ft.
Size - -
No.
Stories,
No. Dw.
Units
New ❑ Add ❑
Alter. 0,-
Repair ❑ Demolition ❑
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
FINAL DATE
Estimated Valuation
$7'r
PERMIT
expiration if work thereunder is suspended for 180 days.
rr
AMOUNT -
Plan Chk. Dep.
I certify that I have read this application and state that the. above information is correct.
Issued by:
Plan Chk. Bal.
I agree to comply with all city and county ordinances and state laws relating to building
_$44.52
Const..
°"
bV . 5U
Mech.
mentioned property for inspection purposes.
i6AU
Electrical
Signature of applicant Date
20 , 00
Plumbing
Mailing.Address
14.00
S.M.I.
City, Slate, Zip
.53
Grading
HARD COPY
, _
Driveway Enc.
Infrastructure
TOTAL
REMARKS
,,.r:xY•'1 X h ti�'•1.k *'7..->!a,1� [sh s 1•
i► _ ro)NJI
s, TA AI S fAl-L:°i
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
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 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.
a
'3/20 E y
I certify that I have read this application and state that the. above information is correct.
Issued by:
Date 0 y Permit
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, Slate, Zip
HARD COPY
, _
T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB./0-
BONDING
YARD SPKLR SYSTEM
2ND FL. S0. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO., FT. ®
GAS (ROUGH)
METER LOOP
GAR. $0. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT. ®
GROUT
WATER HEATER
WALL SO. 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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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 ® 11/4 c
SEWAGE DISPOSAL
INSULATION/SOUND
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./0-
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
�.,•
�i t
J �f
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 �::j