07663 (RPL)_. - -� _ .Sts • ��9���1��, . f ? �. • '. ... ..
51 PP.O. BOX 1504 N o . 07663 • '
Building78-105CALLEESTADO'. a
Address •79-731 iia Smaia LA QUINTA, CALIFORNIA 92253
Owner
A S P#OBUILDING':, TYPE CONST. OCC:•GRP.
Mailing
Address - 787�i1 Via :sono. A.P. Number par 1a quince'
City Zip Tel. ,
Address Tel. .
City ;+;'t,` 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.
SIGNATURE 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, pdorrto its issuance also.
requires. the applicant for such'permit to file a signed statement that he is licensed pursuant to
- -(M6Yh76!,1sions • of• the Contractor's .License Law, Chapter 9 (commencing with. Section 7000) of
i�";,Divlsion' 3 of the. Business and Professions Code, or that. he `is exempt therefrom, and the basis
r .for th`e: alleged exemption: ;-Any. 'violation of Section 7031.5 by any applicant for a permit
subjects the applicant to civil•penaltyof not more than five hundred dollars ($500).
O I, as owner of the property-, or -,my employees with wages as their sole compensation, will
do the work, and the structure isnot 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
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 buildor improve for the purpose of sale.) i.•
❑ 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 Seca- B. & P.C. for this reason
Date / ..tib 4PF%pwner r r •+,'. •. „(
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.) s ,'
:Policy No. Company
O Copy is filed with the city.. O.Certified copy is herebyfurnished.
N CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE -
stimated Valuation
PERMIT
Plan Chk. Dep. -
Plan Chk. Bal. -
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
r
` r
TOTAL
REMARKS
(This section need not be. completed if. the permit is for one hundred dollars ($100) valuation.
'or
La Quirj
z 9M3
less.)
1 certify that in the. performance of the work for which this permit is issued, I shall not.
Legal Description
°.
Contractor
-P601_
Project Description
Date Owner''' ` ' •
Sam
NOTICE ,TO APPLICANT: If, after making this Certificate of Exemption you should become
ZONE: -
BY:
Address
'Minimum
Distances: •'
comply with such provisions or this permit shall be deemed revoked.
Setback
_
Front Setback from Center Line
-
City
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance 'of the'
Zip.
Tel..
..
Lender's Name
e o
Lender's Address
FINAL DATE
1
INSPECTOR
This is a build in g permit when properly filled out, signed and validated, and is subject to .
expiration if work thereunder is suspended for 180 days. • Ir
—,��,
4
I certify that I have read this application and stale 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 j-
�r
State Lic.
' construction, and hereby authorize representatives of this city to enter the above•.
City
;
mentioned property for inspection purposes.
Validated -by:
& Classif..
'
Lic. #
Sq. Ft.
No. No. Dw.
City, State, Zip
Size
Stories Units ;
Arch., Engr.,
f
}� '�
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.. J'lP ��r t byl:
f �i a _�4•- crJ`^ r. yi •�" Yom-- .. ♦Yyfti. -.�.. ,.�
.Designer
': , ' =
New ❑ Add ❑
Alter O Repair ❑ Demolition ❑, 1 ,,, •,
• z
�
Address Tel. .
City ;+;'t,` 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.
SIGNATURE 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, pdorrto its issuance also.
requires. the applicant for such'permit to file a signed statement that he is licensed pursuant to
- -(M6Yh76!,1sions • of• the Contractor's .License Law, Chapter 9 (commencing with. Section 7000) of
i�";,Divlsion' 3 of the. Business and Professions Code, or that. he `is exempt therefrom, and the basis
r .for th`e: alleged exemption: ;-Any. 'violation of Section 7031.5 by any applicant for a permit
subjects the applicant to civil•penaltyof not more than five hundred dollars ($500).
O I, as owner of the property-, or -,my employees with wages as their sole compensation, will
do the work, and the structure isnot 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
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 buildor improve for the purpose of sale.) i.•
❑ 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 Seca- B. & P.C. for this reason
Date / ..tib 4PF%pwner r r •+,'. •. „(
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.) s ,'
:Policy No. Company
O Copy is filed with the city.. O.Certified copy is herebyfurnished.
N CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE -
stimated Valuation
PERMIT
Plan Chk. Dep. -
Plan Chk. Bal. -
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
r
` r
TOTAL
REMARKS
(This section need not be. completed if. the permit is for one hundred dollars ($100) valuation.
'or
less.)
1 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''' ` ' •
- 'y
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
'Minimum
Distances: •'
comply with such provisions or this permit shall be deemed revoked.
Setback
_
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.) ,. .sc•;
Side Setback from Property Line
Lender's Name
e o
Lender's Address
FINAL DATE
1
INSPECTOR
This is a build in g permit when properly filled out, signed and validated, and is subject to .
expiration if work thereunder is suspended for 180 days. • Ir
—,��,
4
I certify that I have read this application and stale 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 j-
' construction, and hereby authorize representatives of this city to enter the above•.
mentioned property for inspection purposes.
Validated -by:
s
Signature of applicant ` Date '
Mailing Address
Validation: '
City, State, Zip
c
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fi •. i. ♦ , i:. .,'i''•Kl r:�a: ... ... �4 , Yt+ i� 1.T
.. J'lP ��r t byl:
f �i a _�4•- crJ`^ r. yi •�" Yom-- .. ♦Yyfti. -.�.. ,.�
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. S0. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO, FT, ®
POWER OUTLET
ROOF DRAINS
CAR P. SD. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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.
SO. FT. ® c
BATH TUB
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Yac
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
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
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFINGO
��
J
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION1, y 02
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL