10357 (AR)• II,, I
44
P.O. BOX 1504 No. 10357
Building78-105 CALLE ESTADO
Address 80-060. Vista Grande LA QUINTA, CALIFORNIA 92253
Owner Jams Clewet
. �'
Mailing BUILDING: TYPE CONST: OCC: GRP. -
Address same A.P. Number 617~22 181-003
City Zip Tel.
La Quinta 92253 Legal Description
Contractor Project Description Room Addition
Address
13-295 Cactus Drive
City Zip Tel.:
DHS 92240 329-0157
State Lic. City
& Classif. 370055 Lic. # : 1677 Sq. Ft. 196 No. No. Dw.
Arch., Engr.,
Size Stories Units
Designer New ❑ Add ❑ 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 /Busin��e•ss!and Professions Code,. and myrllcense is in full force and
��ffei t. ti ,•'i ' � '!, 3
t r.1 / ! '
SIGNATURE' t ° / A • f DATE
OWNER -BUILDER DECLARATION EStlmated Valuation
I hereby affirm that I am exempt from the Contractors License Law for the following 9
reason: (Sec. 7031.5,Business and.Professions code: Any city or county which requires a i
4.00
permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also AMOUNT
-requires the applicant for such permit to file a signed statement that he is licensed pursuant to .. PERMIT
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
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant fora permit Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). - X
0 1, as owner of the property, or my. employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.. % �e b • U D
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, Mech. - 5 •'
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 J -.
of proving that he did not build or improve for the purpose of sale.)
UU
❑ I, as owner of the property, am exclusively contracting with licensed contractors to corn 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.M.I. 1.00.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers 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 X ee .043U. Y U
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE ee., 88 nn P;y t
(This section need not be completed if the permit is for one hundred dollars ($100) valuation 1 t a's'p} rg �?x{} .„i/;• ti%
or less.)
I certify that in the performance of.thg work for which this permit is issued, I shall not
employ any person in any manner so-asho become subject to the Workers' Compensation
Laws of California i, ffi
fOwger. fi !"`�,r_. .t` ; ` tr ✓,1cJ
NOTICE TO APPUCANT"'ARer making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: .
comply with such provisions or this permit shall be deemed revoked.
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
Lenders 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 -
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
IST FL. SQ. FT. ® $
2ND FL SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SO. 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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SEWER OR SEPTIC TANK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRY TRAY
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 ® IVi c
SEWAGE DISPOSAL
BOND BEAM
SQ.FT.GAR ® 3'ic
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 XPLUMBING 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 APPJEQUIP.
REIN F. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
(
WATER SYSTEM
GRADING
cu. yd.
$ plus -x$-=$
LUMBER GR.
FINAL INSP. 2,161f 0-
l 6 Qy
FRAMING /� G
6
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING4QWIV
MESH
INSULATIONISOUND dn
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL