003095 (BCOM)4
P.O. BOX 1504 No. 003095
Building 78-105 CALLE ESTADO
Address 78-099 Calle Es ,3o LA QUINTA, CALIFORNIA 92253
Owner City *f La Quinta
Mailing BUILDING: TYPE CONST. OCC: GRP.-
Address
RP.Address P. 0, BOX 1Q04 A.P. Number 769x-102-007
CityZip Tel.
La t.��j.23�A ����� 564�-e246 Legal Description
Contractor Project Description Perlmif, to 1:+r3nE1t1 "et walkway
NM ERS CCii1Struct1.on Pqxa t"_"p %*4nn i between i:raill�x�
Address -7$-725 1st �,f~inde
City' Zip Tela
Lei Qui 92253 564 2551
State Lic. City
& Classif. . 506812 Lic. # 9663 Sq. Ft. No. No. Dw.
Size Stories Units -
Arch.; Engr.,
Designer New ❑ Add ® Alter ❑ Repair ❑ Demolition ❑
Address Tel.
[3 F�
I City
Zip
State
Front. Setback from Center Line
Lic..# _
i LICENSED CONTRACTOR'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 DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
-
PERMIT
permit to construct, atter, 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
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
-
Plan Chk. Dep.
Plan. Chk. Bal.
Division 3 of the Business. and Professidr s. 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 applicant to a civil penalty of not more than five hundred dollars ($500)1' '
IJ 1, 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
Corls.t. .
.
i builds or improves thereon and who does such work himself or through his own employees,
i provided that such -improvements are not intended or offered for sale. If, however, the building ,
Mech. -
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.)
Electrical
0 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. I.'
such projects with a contractor(s) licensed pursuant to the Contractor's License Law:) •• -
❑ 1 am exempt under Sec. B. & P:C.•for this reason.
Grading
Date Owner
WORKERS' COMPENSATION DECLARATION
I herebyaffirm' 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
O Copy is filed with the city. ,❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM v
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 thg work for which this permit is issued, I shall not
=any person in anymanner so as to become subject to the Workers' Compensation
Laws of California.
Date _ Owner -'
NOTICE TO APPLICANT:I!, after making this Certificate o/ 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 it 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 inspection purposes.
Signature of applicant Date
Mailing Address -
City, State, Zip
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
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
Issuediby:
Date 9/A -/A'7 Permit
Validated by:
Validation:
HARD COPYI
T
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
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. a
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
WALL SQ. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
SQ 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.
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
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 C
SEWAGE DISPOSAL
SQ.FT.GAR ® 3AC
HOUSE SEWER
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.IEQUIP.
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
DEC qg a
.co
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