002632 (BLCK)P.O. BOX 1504
Address
54 4ca' �,,�' DriW 78-105 CALLE CALIFORNIAESTAD9
Address LA QUINTA, ORNIA 92253
Owner
Jams Wa T nwt
Mailing
Address P,Qe B= 6835
City izip
L ontractor
51-625 EL-MbMar
City Zip
ra€i tit 32,.253
State Lic.
& Classif. 39563.
Arch., Engr., - • --
Designer .
T
Tela - "
564-0046
City
Lic. #
No. 002632
BUILDING: TYPE CONST. -OCC. -GRP..
A.P. Number 774-253-010
Legal Description 14
Project Description
Sq. Ft. No. No. Dw.
Size Stories Units
New R Add ❑ Alter ❑
Address Tel.
City Zip State 140 din. ft. Of �'
Lic. #
.LICENSED CONTRACTOj1,S DECLARATION.
I 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.
SIGNATURE N DATE ,
OWNER -BUILDER DECLARATION Estimated Valuation c� A
I hereby affirm that I am exempt from the Contractor's License Law for the following' 2t,7ltVe
reason: S 7031 5 B f and ProfessionsCode: An cif or count which re i
(ec. , us ness y I y qu res a
permit to construct, alter, improve, demolish, or. repair any structure, prior to its issuance also
requires the applicant for such permit to rile a signed statement .that he is licensed pursuant to
-
.PERMIT -
the provisions of the Contractor's License Law, Chapter 9 (commencing with .Section 7000) of
"n.•'
'
Plan. Chk. Dep.
'Division 3 or the Business and Professions Code, or that. he is exempt therefrom, and the'basis
for the alleged exemption. Any violation or Section 7031.5: by 'any applicant for a permit
subjects the applicant to a civil penalty of•not more than five hundred dollars ($500): - • '
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Bal.
Const..
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 or property who
Mech.
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
-Electrical
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
Plumbing
❑ 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
S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -- -
❑ I am exempt under Sec. • B. & P.C. for this reason
Grading
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
'I hereby affirm that I have a certificate of consent to'selUinsure, 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.
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,,,) 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
I Lender's Address
i 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
f construction,and hereby authorize representatives ofthis city to enter the above-
mentioned property for inspection purposes.
i Signature of applicant �_--""�`� �. +1:: 11 Date
i Mailing Address I`
City, State, Zip
HARD COPY
TOTAL
Repair ❑ Demolition -E)
AMOUNT
25.02
38„50
REMARKS
v
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:
DatePermit
Validated by:
Validation:
A6501
10 10 64.02 Ck
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. ®
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®_
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. ®
I
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN
SO. FT. ®
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
WASHER(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.
TEMPUS 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
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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. 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
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
I N SU LATIONISOUN D
FINISH GRADING
/FINAL INSPECTION s
v
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL