002523 (BLCK)4
P.O. BOX 1504 No. 002523
Building- 7&105 CALLE ESTADO
Address 5I=155 ESsenhnue1t rrive LA QUINTA, CALIFORNIA 92253
Owner
Mailing
BUILDING:- TYPE CONST. OCC'. GRP.
Address P.O. L= 704 A.P. Number 773-"5-016g017
City Zip Tel.
z -uirlt 92f 53 • . Legal Description. I 6 CS 7
Contractor Project ,Description
Address
S tl
P. 0. Bm 2289'
City _ Zip Tel..
State Lic. City
& Classif..� Lic. # "; h 'I Sq. Ft. No. No. Dw.
39126_Q ', Size -.. Stories Units
Arch., Engr., t .
Designer New OA Add ❑ Alter ❑ Repair ❑ Demolition Cl
.... Address Tel.
City Zip State of 6—foot *1 GU=0 f:�:
Lic: #
LICENSED:CONTRACTOWS DECLARATION
I herebyy affirm that 1 am licensed under provisions of Ch {herr 9 (commencing with Section -
71100) of:Division;3 of the Business and P.rofsssions,Co I.Mod mya,bense is in=full force and
• SIGNATURE - DATE
OWNER -BUILDER DECLARATION Estimated ValuationI hereby affirm that I am exempt from the. Contractors License Law for the following t! ZC -00
reason: (Sac. 7031.5;Buslness and Professions Code:; Any city or 'county which requires a - W
permit to construct, sitar, Improve, demolish, or repair. any -structure, prior to Its Issuance also
requires
p visions�o the for
aroPa License Law. rmit to rile Chapterned statement
8:( ommencing with Section7000)ed o .PERMIT 'AMOUNT
Division 31 of the Business and Professions Code, or that.
he la. exempt therefrom, anif the basis - -
for the alleged exemption. Any violation of Section 7031.5 by any applicant (or a permit Plan Chk. Dep. - -
subjects the applicant to a civil :penally ofnot more than five hundred dollars'($500).,-
0 I; as owner of+the prop", Plan Chk. Bill.
p party, or my employees with wages as their sole compensation, will "�2"
do-the.work, and the structure is not,intended or offered for sale. (Sec: 7044, Buianess and Cionst.. ;) so
Professions Code: - The Contractors License Law does not apply to an owner of property who ;)m
so
or #Wroves thereon and who does such work himself or through his own employees,-
provided that'such Iriprovements are not Intended.oroffered. for sale. N, however, the building Mech.
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 or 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)Ikerised pursuant to the Contractor's License Law.)
Grading
O 1 am exempt:under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date owner. Infrastructure
WORKERS' COMPENSATION DECLARATION
I'heraby affirm that I have a certificate of consent to self -Insure, or a certificate of
Worker's'Compensation Insurance, ora certified copy thereof. (Sec: 3800, Labor Code.)
Policy No Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 34.32
CERTIFICATE OF EXEMPTION FROM REMARKS.
WORKERS' COMPENSATION INSURANCE
(This section need not be completed." ii -the permit Is for one hundred dollar "(5100) valuation - - -
orless:) - - - - - -
I 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 to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT. f. 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 wahsuch ,provisions orthis permit shall be deemed revoked. - MinimurTi 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
Lenders .Name
Lenders 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. V
I certify that have read this application and state that the above information is -correct. Issued by: Date Permit
I agree to complywith 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-- J Date '"-
Melling Address ' Validation:
City, State, Zip
B613b 8 6 X4,32 4,
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
iST FL. SO. FT. g $
UNITS
COLL. AREA
2ND FL. SO. FT. ,®
YARD SPKLR SYSTEM
POR. SO. FT: ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO., FT. ®
DUCT WORK
DRAINAGE PIPING
WALL SO. FT.
DRINKING FOUNTAIN
SO. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be.used as property tax valuation
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
GRADING
cu. yd.
$ plus x$
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FIREPLACE
SO.FT.GAR ®'YAc
HOUSE SEWER
SPARK ARRESTOR
GAS PIPING
PERMIT FEE
GAR. FIREWALL
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./EQUIP.
EINF. STEEL 2F
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
INSULATIONISOUND
FINISH GRADING
-
FINAL INSPECTION l
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL