09308 (PAT)P.O. BOX 1504 � No. 09308
Building.. 78-105 CALLE ESTADO`
Address 78- 935 Via Melodi.a LA QUINTA, CALIFORNIA 92253
Owner o
Susan B'. Wade BUILDING: TYP,E,CONST-. OCC: GRP.
Mailing
Address same A.P. Number
CityTel.
La 0 -di ta 71922S3
64-2689 Legal Description
Contractor Project Description
City Zip Tel.:
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer
Sq. Ft.
Size
New ❑
No. No. Dw.
Stories Units
Add -0. - 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) of Division 3 of the Business and Professions Code, and my license is in full force and
• effect.
y
r
_SIGNATURE DATE
OWNER -BUILDER DECLARATION------EStlmated
ValUatlOn
1 hereby affirm that I am exempt from the Contractor's License Law for the following
. reason: (Sec. .703 1. 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 /or 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 o/ the Business and Professions Code, or that. he is exempt therefrom, and the basis
%or. 4he Any Section 7031.5 'anyapplicant for
Plan Chk. Dep.
--, alleged exemption. violation o/ by a permit
- subjects the applicant to a civil penalty o/ not more thanfive hundred dollars ($500). -
-
Plan Chk. Bal.
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
C011St. Cg
Professions Code: The Contractor's License Law does not apply to an owner o/ property, who
n ,
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
Electrical -
. of proving that he did not build or improve for the purpose of sale.)
^
❑ 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.W. ,v -
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading t
❑ I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owne ~ r] •� �• - r r ,. ..-
Infrastructure
WORKERS' COMPENSATION DECLARATION
Ihfiereby affirm than 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
❑ Copy is filed with the city. . ❑ Certified copy is hereby furnished. .
TOTAL _
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is /or one hundred dollars ($100) valuation
' or less.)
1 certify that In the performance of thg work for which this permit is issued; I shall not
-
; ?,ate;_t; fj+�}'°j"'� ;�%p�;-,.^;I.!�j ,'•Y�
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. f /a
Date Owner 4% . ..�. "; / !
NOTICE TO APPLICANT: Il,jVer-makirig'this Certi6cate .o/ Exemption you sAould become
ZONE:, - BY:•
subject- to the Workers' Compensation provisions o/ :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
colusrRucTloN 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
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 state that the above information is correct.
'
Issued by: 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. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO, FT. ®
GAR. SO, FT. ®
CAR P. 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 APPJEQUIP.
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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 C
ISEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
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 --I PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
LOLL, 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
H NG (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FI INSP.
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUN
FINISH GRADI
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL