003541 (CRES)Building
Address
Mailing '
Address
4
P.O. BOX 1504 No. 003541
78-105 CALLE ESTADO
60 Dme RalM.,3 Road LA QUINTA, CALIFORNIA 92253
City Zip
La Quints - . - 92253
Contractor
Address... .
City lZip. . .
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 617-090-004
Tel.
347--�$260 Legal Description
Project Description Carport
Tel.
State Lic.
City
& Classif.
Lic. #
Sq. Ft.
No. No. Dw.
Size
Stories Units
Arch., Engr.,
Designer
New ❑ Add O
Alter'❑ Repair ❑ 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
7000) of Division 3 of the Business and Professions Code, and my license Is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION'
1 hereby affirm that I am -exempt from the Contractor's License Law for the following1)
reason: (Seca 7031,5,ausinass and.Professions Code: Any city or county which requires a,
permit to -construct, altar, Improve: -demolish, or repair, any -,structure, prior to Its issuance also-
requlres the applicant for such Penna to file a signed statement that he Is fcensed pursuant to • .
fire provisions of the Contractor's License Law, Chapter 9 (commencing ,with Section 7000) of
Division 3 of the Business: and Professions. Rode, •or that. he is exempt therefrom, and the basis '.
for the alleged exemption. Any violation of Sect/on 7031.5 by 'any applicant for Parma
subjects the applM- t to a clVll penalty of notmore than five hundred dollars ($500). -
13 1, as owner of the property, .or;myemployees with wages as their sole compensation; will
do the work, and tfie'stiucture Is not intended or,offered for sale. (Sec. 7044, BuLsness and
Professions Coder 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. N, however, the building
or Improvement Is sold within one year 'of completion, the owner -builder will have the burden
of proving that he did, not build or. Improve for the purpose.ofsale.). - ..
Estimated Valuation
*�•�g
4 ..
-
PERMIT
-
- AMOUNT
Plan Chk: Dep.
8 _ 22
Plan Chk. Bal.
Const.
-
- Mech.
- -
Electrical -
- - -
Plumbing
-,
❑. 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 contractor(s) licensed pursuant totheContractor's License Law.) -
0..l am exempt under Sec. B. & P.C. for this reason
S.M.I..
- 'f
Grading
Driveway Enc.
Date owner f _ {�_ :�—.,"
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that. I'have a'certificate of consent to self -insure, or a certificate'of
VVorker's Compensation Insurance, or.a certified copy thereof. (Sec. 3800, Labor Code.)
Policy NO. -Comp any
❑ Copy is filed with the, city_ 0 Certified copyis hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
-
-
(This section need not be completed lythe permit is for one hundred dollars ($100) valuation
orless .). _.
1 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 totheWorkers' Compensation
Laws of California.
Date " Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
' subject 'to "the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provision or this permit shall be deemed revoked.
- r y . , ; d ;, - ;j~,.• �r se
-ZONE: BY: j
-
Minimum Setback Distances: -
Front Setback.from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
1 hereby affirm that there is a construction lending agency for the performance of the
work?or which this permit_is issued. (Sec. 3087, Civil Code.)
Side Setback from Property. Line
Lender's Name
-
Lender's Address
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 lead this application and state that the above_ information is correct.
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.
FINAL DATE
'Issued by:
Validated by:
INSPECTOR
tt ,I�
Date1212.3 / 91 Permit
Signature of applicant Date -
Mailing Address
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES y
IST FL. SO. FT. ® $
UNITS
//
L SLAB GRADE — -
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SQ. FT. ®
OTHER APP./EQUIP.
DRAINAGE PIPING
WALL SQ. FT. @
TEMP. POLE
DRINKING FOUNTAIN
SQ FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
_$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(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
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. REBID ® 1% c
SEWAGE DISPOSAL
LATHING
SQ.FT.GAR ® 3Ac
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
INSULATIONISOUND .
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE --JCONST.
FEE ELECT. FEE
SMI FEE FPLUMBFEE
STRUCTURE PLUMBING ELECTRICAL HEATING 3 AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
//
L SLAB GRADE — -
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
)/ /&FOUND. REINF. ��-
�l
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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 —C- �Si
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND .
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL
40030� NO. 1242 - 8%, X 11 35°16' ISOMETRIC
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