07721 (SFD)r
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P.O. BOX 1504 N o . 0 / f 2.1
Building 78-105 CALLE ESTADO .
Address;' 78-30 Via Swine _ LA QUINTA, CALIFORNIA 92253
r - .
Owner
BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address 4S A . ustA Ori. A.P. Number
City Zip Tel. "
R !I<P Legal Description Iruct �''9t'
Contractor Y Project Description phase T—A_i IIA =o
anv�s'
Address ^
City Zip Tela
State Lic: City
& Classif. Lic. # Sq. Ft. 2700 No. 1 No. Dw.
• Arch., Engr.,
Size. Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S' di CLARATION
I hereby affi that I am licensed under progisio s of,Chapter 9 (commencing wlth•Section
7000) of Divr r3 off the Business a d PrPro/}�ossions Code,ffetl and my license�is i fut f, ce�and
��
SIGNATURE!' �--•' .' i.,,.. ..s�..i'/.r'"
OWNER -BUILDER DECLARATION
Estimated Valuation
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
�..�p�
• '
permit to construct, alter; Improve, demolish, orrepairany 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, of the Business and *Professions - Code, or that. he is exempt therefrom, and the basis-
Dep
for the alleged exemption. 'Any violation of Section 7031.5 by 'any applicant for a permit
Plan Chk.
' subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
'
Plan Chk. Bal. -�
08
❑ 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
Const. ?6
Professions Code: The Contractor's License Law does not 'apply to an owner of property who
•00 '
builds or improves thereon and who does such work himself or through his own employees,.
Mech. '�v 50
provided that such improvements are not intended or offered /or sale. If, however, the building.
. •
or improvement, is sold within one year of completion, the owner -builder will have the burden
Electrical '
o/ proving that he did not. build or improve for the purpose o/ sale.)
+98
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing ;'�j,'
60.
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.M.I. 9.45
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading �
0 l am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date owner
i
Infrastructure 3,015.86
WORKERS' COMPENSATION DECLARATION
I 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 4,758.371
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (s 100). valuation
U�— r... e
§f; .- }. 1{ 'f. _i -�
or less.)
1 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: 1/, after making this Certificate o/ Exemption you should 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
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
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 Permlt
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 FEEe
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE KROIUGH
PLUMB. 2 ( Q
ONDING
1
2ND FL. SQ. FT.
FORMS
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CARP. SO. FT. ®
OTHER APPJEOUIP.
DRAINAGE PIPING
WALL SQ. FT.
TEMP. POLE
DRINKING FOUNTAIN.
SQ FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as properly lax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
off ?d //2
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REMARKS:
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
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
OUND PLUMBING / /
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE KROIUGH
PLUMB. 2 ( Q
ONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
WER OR SER6r1A
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) D (-
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$_=$
LUMBER GR.
FINAL INSP.fi( q j
' /
FRAMING bl AD / !l
l c �/
FINAL INSP ((�/]
t� /N
IF
ROOFING
G
off ?d //2
7 ,(7 %d L�
l
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
I GLp-
MESH
INSULATION/SOUND ,2 r[8 Lb
FINISH GRADING
FINAL INSPECTIO - j Lo
1
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
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?rtffiddtO.'4ss'uej' e-hiodirements,ot'section 306,,,of,the, .,Suildinjl'
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tir ertify.ihj';th
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p•building, -.,or. `V
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