002477 (SFD)P.Q. BOX 1504 -No. 002477
Building,;. f," �` _ 78-105 CALLE ESTADO
Address' �'-"� "-'' LA QUINTA, CALIFORNIA 92253
Owner
Mailing BUILDING: TYPE CONST. OCC: GRP.-
Address
*� �6 A.P. Number
City Zip Tel.
92ZS564- Legal Description
Contractor Project Description
'm 4,W31 -le f#a sic' ". =i1£
Address...
9
-City Zip Tela
Re 92201
State Lic. City
& Classif..� 3 Lic: # Sq. Ft. No. No. Dw.
.. .
Size Stories Units
Arch.,.Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition q.
Address Tel.
City Zip State $eft to mchM ham 0awd in
. I . . Lic. #
LICENSED CONTRACTOR'S. DECLARATION mbiU ham • • a _ •
I hereby affirm that I am licensed under provisions of Chapter;9 (commencing with -Section
7000) of Division 3 of the Business and' Professions, and my license Is in full force and
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, 7031.5,Business,and Professions Code: Any city, Or. county which requires -a
permit to construct, alter,. Improve, dathollsh, or repair any structure, prior to its Issuance also -
requires the appI for Such permit torfils 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 - - -
"Oivls/on 3 of the Business and Professions Code; -or thathe is exempt "therefrom, and the basis -
for the alleged exemption. Any violation of Section 7031.5 'by any applicant: for a perms.. -Plan Chk.. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ 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;lanot^Intended or offered for sale. (Sec. 7044, Butsness and CiOr1St.. '
Professions Code: The Contractor's License Law does'not apply to an owner of property who .
builds or lnproves thereon and who does such work himself or through his own employees, Mech.
provided that such improvements are not Intended or offered for sale. ti, 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.) . .
❑ I, as owner of the property, am exclusively contracting with licensed 'contractors to con- Plumbing
struct the project: (Ss:. 7044,- Buslhess•and Professions Code: The Comraotor's License Law
does not apply to an owner of property who. builds or Improves thereon, and who contracts for S.M.1.
Such projects with aroontractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑. I am exempt under-Sec.B. & P.C. for this reason
Driveway Enc.
�
Date r �{ Infrastructure
� � ' c ' % Owner _
j Mbile t a n�l '
WORKERS' COMPENSATION DECLARATION 4
I'hereby affirm that I' have a certificate of consent to self -insure; or a certificate of '
Worker's Compensatiominsurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is flied with the city.. ❑ Certified copy Is hereby' furnished.
TOTAL 70 • %10
CERTIFICATE OF EXEMPTION FROM REMARKS
- WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit is for one hundred dollars, ($100) valuation -
or less:) - - -
I certify that In the performance of the work for which this permit Is Issued; I shall not
employ any person in any manner sous to become. subject to the Workers' Compensation -
Laws of California.
Date ' " ,Owner •
NOTICE TO APPLICANT., 9, after making this Certificate of Exemption you shouts, become - - BY:
-
subject to:'the Workers' Compensation provisions ofIthe 'Labor Code, you must forthwith ZOZONENE: -umSetback"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
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
INSPECTOR -
expiration it.work thereunder is suspended for 180 days.:
I.certify that I have read this application and state that the above Information ds correct. ISSued.by:' Date 7-24 6 Permit
I'agfee 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 Data
Mailing Address Validation:
City, State, Zip
A6039 7 24 7a00 U
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BA/SINK
POR. SO. FT.. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAIR'fs
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SD. FT. ®'
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN
SO 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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SO, FT. @ c,
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/.c
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 FEEPLUMB. FEE
.i
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
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
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$-=$
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 SIGNATURESIINITIALS,
GARDEN WALL FINAL