001965 (RPL)P.O. BOX 1504 �..
Building 78-105 CALLE ESTADO
Address77-144 Via Nuerta LA QUINTA, CALIFORNIA 92253
'Mailing
Address
City y - Tip '
.1a oainty� 922
Contractor
ArirlrPcc
City
State Lic.
& Classif. 32MS
Arch:,•Engr.,'
.Designer
BUILDING: TYPE CONST. OCC: GRP:
A.P. Number
64-1315 ' . Legal. Description ,. r
Project Description
Zip. . . Tel...
92261. 346.4804.
City
Lic. #
Sq. Ft. No. No. Dw.
Size - Stories -Units
New 0. Add ❑ Alter ❑. Repair ❑ -
Demolition ❑
Address
Tel.
City
Zip
State
_.
Lic. # ..- . .....
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing' with Section
7000) offDivision3 of the Business and Professions Code, and my license is in full force and
�+
effect..
SIGNATURE DATE
OWNER -BUILDER DECLARATION
EStlmated VflIUltlOn
hereby -affirm that I am exempt from the Contractor's License Law for the following
•
reason: (Sec. .7031.5, Business and Professions Code: .Any city or county -which requires a
permif. to construct, alter, 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
PERMIT
- 'AMOUNT '
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
~^
Division 3 or 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
Plan Chk. Dep.
- subjectsthe applicant to a civil penalty of not more than five hundred dollars.($500)' `• .
Plan Chk. Bal.
25A2
0. 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-ofIered for sale.'(Sec:"7044. Buisness and
COTISt.38.50
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,.
Mech.
,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'
ElectrlCal
- -
of proving that he did riot build or improve for the purpose of sale.)..
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-'
Plumbing
struet 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.) •'
.. -
Grading
❑ .I am exempt under Sec. B. R P.C. for this reason .
Driveway Enc.
Date Owner
Infrastructure
3
Tritf�ff'�I;it°?r.
� ... ' . .. ..
S2.
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
CERTIFICATE OF EXEMPTION FROM
REMARKS
GG
A5
WORKERS' COMPENSATION. INSURANCE .
(This section need not be completed -if the permit is for one hundred dollars ($100) valuation
or fess.) .. ... ..
•r I certify that in the performance of the 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 ' " Owner -"-
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
ZONE:
BY:
' subject 'to the Workers' Compensation provisions or the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:
Front, Setback.from Center Line
'
Rear Setback from. Rear.Prop. Line
CONSTRUCTION LENDING -AGENCY
Side Street Setback from.Center. Line
Ihereby affirm that there is a construction lending agency for the performance of the
_ work for which this permit is issued. (Sec. 3097,' CivilCode.)Slde
Setback from.Property Line -
Lender's -Name
Lender's Address
FINAL DATE
INSPECTOR
" 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 stale that the above information is correct.
Issued by-
Date 12— 85 Permit
I agree to comply with all city and county ordinances and state laws (elating to building
construction, and hereby authorize representatives ,of this city to enter the above:.
mentioned property f�orrinspection purposes. /
'
Validated by:
Signature of applicants Date l
Mailing Address
Validation:
City, State, Zip `
A3853
1 15 159..52 R.
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
r
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
-T
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)
METERJ�COP
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$
=$
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 SIGNATURESIINITIALS
GARDEN WALL FINAL