003527 (RPL)Building
Address
Owner
P.O. BOX 1504
53-500 Herrera LA QUINTA CALIFORNIA 92253
No. 003527
City
A -&&.i"" "2"°"""`
BUILDING: TYPE CONST. L 0 OCC: GRP.
Mailing
Lie. # _
Address
LICENSED CONTRACTOR'S DECLARATION .
A.P. Number
774 -124 -001 -
City
Zip
Tel.
La .Quints.
-
. -
Legal Description
Project Description
Contractor
Estimated Valuation
PQ�S
Address
permit to construct; alter, improve, demolish, or repair any structure, prior to its issuance also
y
78-755 Martinique
City ""
PERMIT -
Zip
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Tel.
Division 3 of'the Business and Professions Code, &—,that.he'is exempt therefrom, and the basis
for the Any Section 7031.5 by 'any for
Parma
Desert
alleged exemption. violation of .applicant a permit
subjects the applicant tow civil penalty of not more than five hundred dollars ($500).
Plan Chk. Bal.'
w 1112
❑ I, as owner of the property, or my.employees with wages as their sole compensation, will
State Lie.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
City
Professions Code: The Contractor's License Law does not apply to an owner of property who
& Classif.
476807
Mech.
Lie. # 130
Sq. Ft.
No. No. Dw.
a(
'
. of proving that he did not build or Improve for the purpose or sale.)
Size
Stories Units
Arch., Engr.,
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
Designer
such projects with a contractor(s)-licensed pursuant to the Contractor's License Law.)
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
,
Tel.
Driveway Enc.
Date Owner
Infrastructure
City
Zip
State
Lie. # _
LICENSED CONTRACTOR'S DECLARATION .
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division'.Tof the Business.and Professions Code, and my licenseis in full force and
effect.
,DATE
-
SIGNATURE"'
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
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, &—,that.he'is exempt therefrom, and the basis
for the Any Section 7031.5 by 'any for
.Plan Chk.Dep.
AQA
alleged exemption. violation of .applicant a permit
subjects the applicant tow civil penalty of not more than five hundred dollars ($500).
Plan Chk. Bal.'
w 1112
❑ 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
Const.
';��
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,
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
a(
'
. 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-
Plumbingy
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
0 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. ,Company s
Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
/�"�, •c �^ _
CERTIFICATE OF EXEMPTION FROM _
REMARKS
'
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (5100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
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employ any -person in any manner so as to become subject to the Workers' Compensation
Laws of California.
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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.
12/ 6/
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 Date .
Mailing Address
Validation:
'
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
YARD SPKLR SYSTEM
2ND FL. SO. FT. a
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
HEATING (FINAL)
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
CAR P. SO. FT.
WATER HEATER SERVICE
FINAL INSP.
WALL SO. FT.
DRINKING FOUNTAIN
SO. FT. ®
GRADING
cu. yd.
$ —Plus—X$—=$
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
ROOFING
FLOOR DRAIN
MECHANICAL FEES
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SSS �G L
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
LATHING
GARBAGE DISPOSAL
FURNACE . UNIT WALL FLOOR SUSPENDED
FINISH GRADING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FENCE FINAL
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. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
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
� e -
SETBACK
GROUND PL M / 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) �L 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$—=$
a,
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
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INSPECTOR'S SIGNATURESIINITIALS.
REMARKS:
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VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTORe12
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
GARDEN WALL FINAL