001691 (BLCK)P.O. BOX 1504 N o , 001691
Building
Address 54-395 RLSelftr4W LA QUINTA CALIFORNIA 92253
psamt. Design
BUILDING: •TYPE CONST.
A.P. Number
Legal Description
Project.Description
OCC. GRP.
StI13013D Pte' around
Mailing-
Address P.Q. Bim 1420
j City
.
Zip
2253
Tel.
564-016..
Contractor
I applicant
Address ...
above
Side Setback from Property. Line
' City
Zip
Tel. ...._ .
Issued by:
Date 8'°22 $S Permit.
State Lic.
& Classif.
City
Lic. #
Sq. Ft.
Size 210
No. No. Dw.
Stories - Units
Arch., Engr., _ -....
Designer
New Add ❑
Alter ❑ Repair ❑ Demolition ❑•
Address
Tel.
City
_
Zip
State
Lic. #
i. LICENSED CONTRACTOR'S DECLARATION _ ...
I hereby affirm that I am licensed underprovisions of Chapter 9 (commencing with Section'
7000) of Division 3 of the Business and P.r6fessions Code, and m license.is in full force and
effect.f
/ t
SIGNATUREk - "Y ,i DATE
- OWNER-BUILDER'DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Busfness and Professions Code: Any city or county which requires. a
I permit to construct, alter, improve, demolish, or repair any structure, prior to its. issuancealso�•^
requires the applicant for such permit to file a signed statement. that he is. licensed pursuant to
. 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 alleged exemption. Any violation of Section 7031.5 by 'any- applicant Jor a 'permit
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.
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 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
of proving that,he did not build or improvefor the purpose of sale.) • -
❑ 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 of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
0.1 am exempt under Sec. B. & P.C. for this reason
Estimated Valuation
PERMITS
AMOUNT
plan Chk. De p .
'
Plan Chk. Bal.
19„1'
COnSt.
.
Mech.
.
Electrical
Plumbing
S. M. 1.
-
Grading
-
Driveway Enc.
Date—Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
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.)
-
-
i Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
i CERTIFICATE OF EXEMPTION FROM
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, 1 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, 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
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.) -
Lender's Name
Lender's Address
'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. '
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 -of this city to enter the above-:
mentioned property for in spectioii:'purposes.
Signature of applicant' i ,fir r - rr Date
Mailing Address v wK
City, State, Zip
HARD COPYI
T
TOTAL 49.17
REMARKS
ZONE:
BY:
Minimum Setback Distances:
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:
Date 8'°22 $S Permit.
Validated by:
Validation:
A 2 3 8 2
.8 22_* 4'9,17 R
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. Q. FT. ®
GAS (FINAL)
WALL SO. FT. ®
DRINKING FOUNTAIN
SQ. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ Plus -X$-=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
`
i MFINAL INSP. S/
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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.
SQ. FT. @ c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
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.
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
`
i MFINAL INSP. S/
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING a 0
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
q
FENCE FINAL
1
ark
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL