05254 (SFD)4
P.O. BOX 1504 No. 05254
Building 78-105 CALLE ESTADO
Address 48'-118 Via Hermosa LA QUINTA, CALIFORNIA 92253
Owner
Mailing
BUILDING:, TYPE CONST. OCC: GRP.
Address 13010 Co1cbis Ave. Suite 'I
A.P. Number
�►I?—h4#2—l°327
City Zip
Tel.
;n 91,37-4
8 18y. t �l..5 R 4
Legal Description
Contractor
Project Description
!Pi,*" A A: _ Tsai' 1>7
Address
77-20.0 'Hitinesats 1*1
City
ZipTel.:
rAlft
State Lic.
City
& Classif.
Lic. # a
Sq. Ft:
No. No. Dw.
i9 3
Size, :1562 ._.
Stories Units
Arch.;Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section r
- 7000) of biwsion 3 of the Business and Professions.Code, and my license is in full forced andff
effect
SIGNATURE �" ,- •• P �.� .. ../ 1 DATE X
�\ OWNER -BUILDER DECLARATION /' /
Estimated Valuation
I hereby-affign that 1 am exempt from the Contractor's License Law for the following.
�s
$ 3
reason: (Sec. 7031.5,Bu�ess and Professions Code: Any city or county which requires a
f1
permit to construct. after, improve, demolish, or repair any structure, prior to its issuance also
req,dres the epp5card for such permit to We a signed statement that he is licensed pursuant to
PERMIT
AMOUNT ^
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of -
• Oivision 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exenptian. Any violation of Section 7031.5 by 'any applicant for a permit
Plan Chk. Dep.
_
. .
subjects the applrcanfto a civil penalty of not more than rive hundred dollars ($500).
❑ 1, the
Plan Chk. Bal.
$ 319.16
as owner of 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, Busness and
I
Const.
°,y" 8 2 £ j 0
Wessions Code: The Cavntractces 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,
Mech.
.,
36.00
• provided that such building
improvements aro not intended or offered /or sale. !f, however, the buiM'
or -improvement is sold within me year of completion, thowner-builder will have the burden
Electrical r
/ •
ata
" of proving that he did not build orimprove for the u )
�..1.
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
22.00
struct the project. (Sec. 7044, Business and Professions Code: The Contractors License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
S.M.1.
- 5.78
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec B. 8 P.C. for this reason
Driveway Enc.
Date owner m
Infrastructure
1,848.24
Frinae-Toed Lizard 131'.06
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.)
Policy No Company
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
$ 2 8 M U
CERTIFICATE OF EXEMPTION FROM
REMARKS'
r
WORKERS' COMPENSATION INSURANCE.
(rids section need not be conpleted if the permit is for one hundred do8ers (S100) vahration
mt II certify that in the performance of the work for which this permit is issued, I shall nuit
�a
:'S yx�IN ° q x E Y
� ., f� sTY 3 Iv i 0 Z44
employ any person in any manner so as to become subject to'the Workers' Compensation
Laws of Cali oria
_.
Date owner
"N077CE
TO APPLICANT: B, after making this Certificate of Exemption you should become
ZONE:
BY: '
subject to the Workers' Cmrpensafion provisionsof the Labor Code, you must forthivith
corrpywansuchProvisions or this permit shag bedeemed revoked.
Minimum Setback Distances: �
r
Front Setback from CenterrLine'
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 the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Side Setback from Property Line
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to.FINAL
DATE
INSPECTOR
expiration if work thereunder is suspended for 180 days.
I certity that I have read this application and state that the above information is correct.
Issued by:
y
e �,.
Date Permit
1 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.Validated
by:
Signature of applicant Date
. Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
+UNITS
COLL. AREA
LAB GRADE (Q
YARD SPKLR SYSTEM
2ND FL Sp. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. Sp. FT. ®
DUCTWORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
GAS (FINAL)
WALL Sp. FT.
DRINKING FOUNTAIN.
-
URINAL
Sp FT ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
cu. yd.
$ plus x$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP./® 3 p
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
VENTILATION
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
GAR. FIREWALL
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11A c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
____jCONST.
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE / PL}9MBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
UND PLUMBING Z
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE (Q
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
OR SEP
ROUGH WIRING,
DUCTWORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) O
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUM ER
FINAL INSP./® 3 p
FRAMING (1l$'
^
INAL INSP. ��/�
v�
ROOFING ,
YY�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING f v
MESH
INSULATION/SOUND I
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
`
GARDEN WALL FINAL