002630 (BLCK)P.O. BOX 1504 No. 002630
Building 78-105 CALLE ESTADO
AddressLA QUINTA, CALIFORNIA 92253
Mailing- -
Address i �Oq 704
City Zip Tel.
ress . .. . .
& Classif..3_07169
Arch.,, Engr.,
Designer
Address
Tel.
I.Lic. #
Tel.
City Zip State
I. - . _ . Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of, Chapter 9 (commencing with Section
7 o Dlvislof 3 of the Business and. Professions Code,. and my license is in full force and
effecI..-
w
SIGNATURE _ --f DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Buslness and Professions. Code: Any. city or county which requires a
permit to construct, after, Improve; demolish, or repair any structure, prior. to its issuance also
requfree the_applk:aril for such permit to file a signed statement that he Is Ik:ensed pursuant to
the prov=s . of Me Contractor's License Law, Chapter 9 (_commencing with Section 7000) of
Division 3 ofthe BusinessandProfessions Code, or.that.he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any _.applicant for a' permit
subjects the'app/ioant'ro a cMl penalfy'of not more than Rive hundred dollars ($500). -
O I, 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
Professions Code: 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 knprovements are not Intended or offered.for sale. If, however, the building. -
.or improvement Is sold within one year of completion, the owner -builder wlll.have the burden
of proving that he did no! build or Improve for the purpose of sale.)
0 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 ofpropertywho builds or Improves thereon, and who contracts for
such prglacts.with acontraclor(s)-licensed pursuant to the Contractor's License Law.) - - -
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
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
❑ Copy Is filed with the city. 0 Certified copy Is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hundred dollar; (E 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 so as to become, subject to•the Workers'' Compensation,
Laws of California.
DateOwner
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 provisions or this
permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm, thatahere is a construction lending agency for the performance of the
work forwhich this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This isa 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 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 •iof this city to enter the above-
mentioned property for Inspection purposes.
Signature of applicant `J : Date
Mailing Address r )
City, State, Zip
HARD COPY
ALDING: TYPE CONST. `OCC: GRP.
P. Number `iia -4)6_5.0.°x.6. 1*1
!gal Description lots 6 and. 7
oject Description
REMARKS
Sq. Ft. No. No. DIN.
Size 130- lin stories- Units
New Add -_0 Alter ❑. Repair ❑ .
Demolition ❑
Front Setback, f rom.Center Line
kC6t bigii wood feria
Rear Setback from Rear Prop. Line
Side Street Setback.from Center Line
Side Setback from Property Line
FINAL DATE
Estimated Valuation
$
Issued by:
PERMIT
AMOUNT
Plan Ch -k. Dep.
Plan Chk. Bal.
13.32
Const.
20 a so
Mech.
Electrical
Plumbing
S.M.I.
$j
Grading
Driveway Enc.
Infrastructure
TOTAL
34.32
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback, f rom.Center Line
Rear Setback from Rear Prop. Line
Side Street Setback.from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date ' 2-7—Ar) Permit
Validated by:
Validation:
Ab464'
10 ) 54.32 Cit
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
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. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEQUIP.
DRAINAGE PIPING
CARP. SO. 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
=S
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
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T,U.
SQ. FT. ® c
BATH TUB
GAR. FIREWALL
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID a 11/4 c
SEWAGE DISPOSAL
MESH
SQ.FT.GAR @ V4c
HOUSE SEWER
INSULATIONISOUND
GAS PIPING
PERMIT F.EE
FINISH GRADING
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 APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=S
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING-
� D �
�� � �
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