002355 (BLCK)TWT
"
P.O. BOX 1504 No. UU23bb
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 774-061—M.
Legal Description
Project Description
Building
Address 53-+40 E3W Dr3t.Ve
r..
Owner
Fries Eom`ayei
Mailing
Address 53-440 Eipmftwer Drive
City Zip Tel
La i3FDXt I 9223
Contractor
Address
32--050 SkV Blue ifdter tW
'City " Zip Tel
Lit C3. 3222
State Lic.
City
& Classif. 301 880
Lic. # amai®d
Sq. Ft.
No. No. Dw.
Size
Stories Units '
'Arch., Engr.; .. .
Designer
New CIX Add ❑
Alter ❑' Repair ❑ Demolition ❑
Address
Tel.'
200 31M.
ft. of block
City
Zip
State
-Lic. #
LICENSED CONTRACTOR'S DECLARATION
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 , /
. ') 01. 1'e t(, ;P ;i -P } 4. jt `-tom: /� V,1/t!f.
_ .
SIGNATURE dY -"' c- i t f' ) "DATE
_ •.
_ . • _ ._ ,.
' OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
T%r_AEi'
. reason: (Sec. 7031.5, Business and Professions Code: .Any city or county which requires •a
permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance also
,.requires the applicant for such permit to file a signed statement that he is licensed pursuant. to
PERMIT "
.ri .
AMOUNT
.i the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
-
'.Division 3 of the Business and *Professions Code, or that.he'is exempt therefrom, and the basis
for the Any Section 7031.5 by 'any for
,• Plan Chk. De p
alleged exemption. violation of applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
.
Plan Chk. Bal.
'
❑ 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
Const.
_7,2
Professions Code: The Contractor's License Law does not apply town owner of property who
'
builds or improves thereon and who does such work himself or through his own employees, "
Mech
provided that such improvements are not intended or offered for sale. If, 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.)
-
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
struct the project. (Sec: 7044, Business and Professions Code* -The Contractoi's- License Law
-
does not apply to an owner of property who builds or improves thereon, and who contracts for
S. M. 1. - -
Q(}
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
.
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
hereby affirm that Phave 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. ❑ Certified copy is hereby furnished.
TOTAL
93.72
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 -so as -to become subject to the Workers' Compensation
Laws of California.
'^
Date Owner
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption- you should become
ZONE:
-:BY:
subject to the Workers' Compensation provisions of the Labor ,Code, you must forthwith.
comply with such provisions or this permit shall be deemed revoked. -
_ Minimum Setback Distances:
Front Setback from Center,Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
Ihereby 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
- "This
FINAL DATE
INSPECTOR
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
�L7
certify that I have read this application and state that the above information -is correct.
Issued by:
Date- Permit
I agree to comply with all city and county ordinances and state laws relating,to building
I construction, and hereby authorize representatives' -of this city to enter the above-.
I mentioned property for insaction purposes. }f
iSignature (XICil
Validated by:
of applican >° _7 : ?� lith% Y 1111• It i Date _�•^
Mailing Address t f1 i "`''
Validation:
City, State, Zip
A554U
5 7 93.72 CK
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. a $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. a
GAS (ROUGH)
METER LOOP
GAR. SO. FT. a
POWER OUTLET
I ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SQ. FT.
ROUT
CL n
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN
SQ. FT. a
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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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. a c
BATH TUB
LATHING
SQ. FT. a c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID a 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR a 3/4c
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
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
ROUT
CL n
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM �L�
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 SIGNATURES/INITIALS
GARDEN WALL FINAL