003211 (BLCK)44
P.O. BOX 1504 No. 003211
Building 78-105 CALLE ESTADO
Address 77-'$30 Hit elorn LA QUINTA, CALIFORNIA 92253
Owner
�'� " ara #�► BUILDING: TYPE CONST. OCC: GRP.
Mailing j
Address some
A.P. Number 7793-009
City JZip Tel.
Le •Qu%� _ 92233 Legal Description
Contractor Project Description b1 HIRb X 1251 U Feltce
..Address
City Zip Tela "
State Lic. City
& Classif.. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr.,
Size - Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair O Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION ^
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70 00) of Division 3 of the Business and Professions Code, and my license is in full force and
i. effect.
I
i 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. 703.1. 5, Business and Professions Code: Any city or county which requires a _
I permit to construct, alter, improve, demolish, 'or repair any structure, prior to its, issuance also AMOUNT
requires the applicant for such permit to file a signed sta!ement that he is licensed pursuant to .PERMIT
the provisions of the Contractor's License Law, Chapter 9.(commencing with Section 7000) of .r
Division 3 of the'Business and Professions Code, or that, he is exempt therefiom, and the basis
for the alleged exemption.Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
' 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 Plan Chk. Bal.
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. ^..1)t'�i� _ MIN,
builds or improves thereon andwho 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
of 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- 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.) - -
O I am exempt under Sec. Grading B. & P.C. for this reason -
Driveway Enc.
1Date Owner r r J ,. 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
.O Copy.is filed with the city. O Certified copy is hereby furnished.
TOTAL pin_M
CERTIFICATE OF EXEMPTION FROM REMARKS -
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is foronehundred dollars ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not tI {) r.17 ; 0 j 416-27 1
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 tb 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
Ihereby 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.
I certify that I have read this application and state !hat the above information is correct. Issued by: Date 7.10107 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, State, Zip
HARD COPY
T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
A.C. UNIT
COLL. AREA
1ST FL. SQ. FT. ® $
UNITS
BONDING
HEATING (ROUGH)
YARD SPKLR SYSTEM
2ND FL. SQ. FT. ®
SEWER OR SEPTIC TANK
ROUGH WIRING
POR. $Q. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. ®
GAS (FINAL)
TEMP. POLE
WALL $0. FT. ®
DRINKING FOUNTAIN
SQ. FT. ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
�. DEC
LAUNDRY TRAY
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.
SQ. FT. ® c
BATH TUB
SPARK ARRESTOR
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LATHING
SQ.FT.GAR ® 3/ac
HOUSE SEWER
MESH
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.IEOUIP.
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
1 7 1,027
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
CO,fi►)ER
T7,
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A c rr ri r Opts
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