001966 (RPL)Building
Address
77_147 Via M
Owner
�t
Mailing
Lic. #.
Sq. Ft.
Size -
Address
r.o• B= 7$o
City
Alter ❑ Repair ❑ Demolition ❑
Zip
.... ..
JJ4 Mdzlita
9225
Contractor .
City
Address
State
.�• 1,93
City Zip ...
44
P.O. BOX 1504 N u . 001966
78.105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST: OCC: GRP.
A.P. Number 5.
Legal Description
Pr6ectbescription
State Lic.
City
& Classif..
323
Lic. #.
Sq. Ft.
Size -
No. No. Dw.
Stories Units
•
Arch., Engr.,
Designer
Newj& Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
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. tf
- -_
' SIGNATURE \ DATE'
• OWNER -BUILDER DECLARATION '
hereby affirm that I am* exempt from the Contractor'License Law for.the following
s
reason: (Sec. 7031.5,Business and Professions Code: Any .city. or 'county which requires a
' permit 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
the provisions of the Contractor's License Law, Chapter .9 (commencing with Section 7000) of
' 'Divisloh 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 live hundred dollars (S500):'
❑ I, 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
Estimated Valuation
w�
Gp �•j�
'
PERMIT.'
.•s AMOUNT
Plan Chk.• Dep..
Plan _ Ch k.. BBI,
25.02 WJ1,
Const.
•+
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
or improvement is, sold within one year or completion,. the. owner -builder will have the burden
of proving that he did not build or improve (or the purpose of sale.) -
Electrical
/�� ,
•tTLl
Plumbing
- B•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..) -
0.1 am exempt. under Sec.. B. & P.C. for this reason
S:M.I.
.
s
Grading
Driveway Enc.
Date owner
Infrastructure
V
WORKERS' COMPENSATION DECLARATION
w ' ' I hereby affirm that 1 have a certificate of consent to .self-insure,•oYa certificate.of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
-
" Policy No. Company
❑ Copy is filed with the city. 0 Certified copy.is hereby:furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed if the permit is for one -hundred dollars ($100) valuation
or less.) .. ...
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 ' ' Owner
NOTICE TO APPLICANT: df, 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.
'ZONE: BY.: • '
Minimum Setback Distances: -
-Front
Setback from Center -Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Ihereby 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 Street'Setback from Center Line
Side Setback from Property Line
Lender's Name
FINAL.DATE
Issued by:
Validated by:
Validation:
INSPECTOR
Date Permit
Lender's Address
..
' 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.
agree to comply with all 'city 'and county ordinances and state laws relating,to building
construction, and hereby authorize representatives Pf this city to enter :the above-,
mentioned property for inspection purposes.;F
Signature of applicant' ~f t j Date
Mailing Address
City, State, Zip
A3847
1 1_.5 X9,52
HARD COPY
CONSTRUCTION ESTIMATE Admk
NO. ELECTRICAL EESAml
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. SQ. FT.
WALL SQ. FT. ®
SQ. 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
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 APP./EQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. ® c
BATH TUB
SQ. 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
REMARKS:
VENTILATION
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL