002877 (BLCK)Building
Address 55491 xFi=.
Owner
4 lwQ�w
P.O. BOX 1504
78.105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. 00287?
"
a_,CPW*A% ` " "' BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address 'j ,-005 ,(bvU*Xy Ch3b tWiVa A.P. Number
City Zip Tel.
i D - 92264 568-2US Legal Description
Contractor Project Description'
NC3ticnhLl Y=tcptm and L-6rd
Address Kiwi. Wc"1' I" PhOW 14D
City " Zip Tela
State Lic. I City
& Classif. ' 288130 Lic. # 320
Arch:, Engr., • ' -
Designer
Address Tel.
City Zip State
. . Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I amylicensed under provisions of Chapter 9 (commencing with Section
7000) of Division of the Business ,and Professions Code, and my license is in full force and
r• f
i effect./....t' �...:.................:. �.... =`r�•) .. a ..� ...
I SIGNATURE DATE
7 % %✓ OWNER -BUILDER -DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: '(Sec. 7031.5,Business and, Professions Code: Any city or county which. requires a
permit to construct, alter, improve,o 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 r' -
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 for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500):
O 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
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 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 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.) - -
❑ 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
O Copy.is filed with the city.. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE -
(This section need not be completed i1 the permit is for one hundred dollars ($100) valuation
or less.)*
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation '
Laws of California.
Date -:7 -:--Owner
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked., '
Sq. Ft. No. No. Dw.
Size 1488 I,Sii ft.Stories Units
New rX Add ❑ Alter O. Repair ❑ Demolition ❑
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
stimated Valuation
S 1ZPMAWM 37.200.00
_
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
X$.Q
Const.
229.40
Mech.
DATE
Electrical
This is a building per when properly filled out, signed and validated, and is subject to
Plumbing
S.M.I.
- 2.63
Grading
1 certify that Lhave read this application and state that the above information is correct.
Driveway Enc.
Date Permit
Infrastructure
construction, and •hereby authorize 'representatives -of this city to enter the above-
bovementioned
mentionedproperty for inspetctio�mpurposes. r"
Validated by:
Signature of applicant's %;'t. Date
TOTAL
390.48
REMARKS
Validation:
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from'Center Line
I hereby affirm that there is a construction lending agency for the performance of'lhe
_ work for which this permit is issued. (Sec. 3097, Civil Code.) -
Side Setback from Property Line
Lender's Name
Lender's AddressFINAL
DATE
INSPECTOR
This is a building per when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days. -
1 certify that Lhave 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
construction, and •hereby authorize 'representatives -of this city to enter the above-
bovementioned
mentionedproperty for inspetctio�mpurposes. r"
Validated by:
Signature of applicant's %;'t. Date
Mailing Address
Validation:
City, State, Zip
A 7 2 1 6
1 30 38u48 CK
J HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST 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. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. S0. FT. ®
GROUT
WATER HEATER
WALL SO. 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.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
"
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.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./EOUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS"
GARDEN WALL FINAL