003085 (RR)Building 47--8.00 ElseXlhQ'f er
Address
•4
4 -A
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
vwlrcx 7obland Ratty. .-
Mailing
Address
City
Contractor
i
Address..
Zip
Tel.
P&IM- S Zip 92277 Tel.. .367-468f
State Lic. City , q),j
rl<Classif. G39 •e 367464 Lic. # ,
Arch., Engr., ..
Designer
No. 003085
BUILDING- TYPE CONST. OCC: GRP..
A.P. Number'
Legal Description
Project Description
Sq. Ft. No. No. Dw.
Size Stories -Units
New ❑ Add ❑
Alter ❑ Repair IN
Demolition ❑
Address
Tel.
City
Zip
State
LIC. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 am licensed under provisions of Chapter.# (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is infull.force'and -
effect.
SIGNATURE OATS
OWNER -BUILDER DECLARATION ` '
Estimated Valuation
1 hereby afflrin that 1 am exempt from the Contractor's License Law for the following
a t
. reason: (Sec., 7031.5,Buakess and Professions Code: Any city or county -which requires a
permit to constrict, -after, hnprove, demolish, or repair any structure, prior to its. issuance also
- .. ...-
=r requiresMe epptkant for such permft to rrle.a signed statement that he is licensed pursuant to
PERMIT - - .
- AMOUNT- '
-es bra o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and'Protesslions Code, or thathe is exempt therefrom; and'the basis
Section 7031:5 'any -for a
_
Plan Chk. Dep. - -
for the alleged exemption. Any violation of fly. applicant permit
subjects the applicant to a clWl penalty of not more Man fIve hundred dollars ($500). -
Plan Chk. Bal.
0 1, 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:'
$20.00
Prolesskurs Code: The Contractor's License Law does not, apply tq. an owner of property who
- builds or Ioproves thereonand who does such work himself or through his own employees,
Mech.
provided that such improvements are not Intended or offered for sale. lf, however, the .building
or improvement is sok! -within one year of completion, the owner -builder. will have the burden
Electrical ' ' -
_ of proving Mat he did not bu/M.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. (Sec. 7044, Business and Professions Code: The Contractor'slicense law
does not apply to an owner of property who builds or knproves thereon, and who contracts for -
S.M.I. -
'
such projects with a contractor(s) Licensed pursuant to the. Contractor's License Law.)
Grading
.50
-O. 1 am exempt under.Sec.- B. & P.C. for this reason
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, ora certified copy thereof. (Sec..3800, Labor Code.)
Policy No" Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. .
TOTAL2�m�
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed. if the permit Is -for one hundred dollars (S 100) valuation
or less.) .. _
I certify that in the performance of the work for which this permit,is issued I shall not
employ any ppeemon In any manner so as to become subject to the Workers' Compensation'
laws of California
Date Owner
NOTICE TO APPLICANT: N, after making this Certificate or Exemption you should become
• subject to the Workers' Compensation, provisions: of the Labor Code;' you must 'forthwith
comply with such provisions or this permit shall be deemed revoked. - -
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of -the
work for which this permit is issued.,(Sec. 3097, CIO Code.)
Lenders .Name
Lenders Address
This'is a building permit when properly filled out; signed and validated, and is subject to
expiration If work thereunderis suspended for 180 days.
I. certify that l have read this application'and state that. the above Information is correct.
I agree to comply with all city and county drdinances and state laws relatiog'to buildirig
construction, and hereby authorize representatives -of this city to enter theabove..
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, Staie,'Zip
HARD COPY
REMARKS
ZONE: BY: ' r;,•.
Minimum Setback Distances: ' r'�'•`? a "' }:Ct' ` `' ` :-': ,'s4.."``
Front Setback from Center.Line
Rear Setback from.Rear Prop. Line
Side Street -Setback from Center Line
Side;Setback from. Property Line
FINAL DATE INSPECTOR
Issued by: DateA/7-V87 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
POR. SQ. FT: ®,
MOBILEHOMESVC.
BAR SINK
GAR. SQ. FT. @
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APP./EQUIP.
DRAINAGE PIPING
CAR P. I SQ. FT.
TEMP. POLE
WALL SQ. FT. ®.
GROUT
DRINKING FOUNTAIN
SQ FT ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE', DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTIONSYSTEM. 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
GAR. FIREWALL
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
MESH
SQ.FT.GAR ® 3Ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMITTEE
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./EQUIP.
REIN F. 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