08743 (BLCK)44 .4
P.O. BOX 1504 N o .
Building 78-105 CALLS ESTADO
Address 78-685 VIA MELODIA LA QUINTA, CALIFORNIA 92253
Owner
Tsar eeAneraft WAT-1-
Mailing
Address
City
Contractor
Address
City
Zip
Tel.:
State Lic.
& Classif.
City
Lic. #
Arch., Engr.,
Designer
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
70 OO) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
�GNATURE • DATE
OWNER -BUILDER DECLARATION
I 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
,.permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
.requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
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).
❑ 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 or 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.)
O 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 ofproperty who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
O l am exempt under Sec. B. & P.C. for this reason.
Date Owner.
r,.
WORKERS' COMPENSATION DECLARATION
Ihereby 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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this CeRificate or Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
08 743
BUILDING: •TYPE CONST: -OCC. GRP.
A.P.-Number
Legal Description `
Project Description Tt?^Pt X WATT. V$jX4g_R F alt --V
2 s HZGH I0' BOOCK VKLL PLANTER,
Sq. Ft. No. No.' Dw.• .
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑• Demolition ❑
Estimated Valuation
$2,500
PERMIT
AMOUNT
Plan Chk. Dep.
CONSTRUCTION LENDING AGENCY
Plan Chk. Bal
S'ide Street Setback from Center Line
Const.s
_Eio
Mech.
work for. which this permit is issued. (Sec. 3097, Civil Code.)
Electrical
Side Setbac m Property Line
Plumbing_ ,
S.M.I.
Lender's Address
Grading
INSPECTOR
Driveway Enc.
Infrastructure
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.
Issued by:
Date Permit -
I agree to comply with all city and county ordinances and state laws relating to building
TOTAL S45,:. 14
REMARKS
0
Validated by:
Signature of applicant Date'
Mailing Address
ZONE: BY:
Minimum Setback Distances:
\ Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
S'ide 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 Setbac m 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 if 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 -
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-.
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. ® $
2ND FL. • S0. FT.
POR. SO. FT. ®`
GAR. SO. FT. ®
CARP. SO. FT.
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YAPD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM �s
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
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 a/ PLUMBING ELECTRICAL HEATING & AIR GOND. 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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM �s
�Q
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
r
REMARKS:
VENTILATION
r FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR,
GAR. FIREWALL
a
LATHING
MESH
INSULATION/SOUND
FINISH GRADING'
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL