003531 (RER)44
P.O. BOX 1504 No. 003531
Bsilding 78-105 CALLE ESTADO
Address 48-242 Nista Del-_NOpa .. LA,QUINTA, CALIFORNIA 92253
fl• -un pr
Address
City
Zip
'CRY ... . Zip
PaIM ire rt
State Lic.
Classifi. .3146334
-.Ach., Engr.,
Designer
Address
BUILDING: TYPE CONST. OCG:.GRP: •
A.P. Number
Tel. .: w.
'Q42 Legal Description
Project. Description Hiiimodel kite }en . e' nil C.s�1a7iae
" Tel.''
32260 346-9865
City
Lic. 20 #3 Sq. Ft. No.
Size - Stories
Tel.
New ❑ Add ❑ Alter ❑
No. Dw.
Units
Repair ❑ - Demolition ❑
City
Zip
State
Lic. #
n.
LICENSEDCONTRACTOR'S'DECLARATION;,
�•
• 1 hereby affirm that,l am licensed" under prm&ons.f Chapter 9 (commencing with Section
7000) of Division -3 -of the Business and Professions' code, and my license is in 9-(commencing,
and'
,,. ,. ,,,,, ,-• ,
SICNATDRE "..- DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am.exempt from the Contractor's License Law for the following
Estimated Valuation h p �n
0'000
reason: (Sec. 7031.5,Business and Professions Code: Any city or. county.,which requires a.
PERMIT • • •• AMOUNT
pe:mif• to construct, alter, improve, demolish, or repair any structure,. prior to its issuance also-
recuires the applicant for such permit to file a signed.statement that he is licensed pursuant to -..
the provisions of the Contractor's License Law, Chapter9 (commencing with Section 7000) of
lkrsion 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
"• 'suyects the applicant to a civil penalty of not more than rive ,hundred dollars ($500).
O 1, as owner of the property, or my employees with wages as theirsole compensation; will
'
-
Plan.Chk. Dep. - --
Plan Chk. Bal. �i 2 321
Const. {�(1
do the work, and the structure is not intended or offered. for sale: (Seca 7044, Buisness and
Professions Code; The Contractor's License Law does not apply to an owner of property who .
Mech.
budsd
or improves thereon anwho does such work himself or through his own employees, .
„provided that'such improvements, are not intended or offeredforsale..lf„however, the building '
Electrical
• or:improvement is sold within one year of completion,the'owner-builder will have the burden
of proving, that he did not build or improve for the purpose ol.sale.)
Plumbing -
❑.I, as owner of the property, am exclusively contracting with -licensed. contractors to con- -
stnret the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
dues not apply to an owner of,property who builds or improvesthereon, and who contracts for
such projects with acontractor(s) licensed pursuant to the Contractor's License Law.)- -
❑ lam exempt under Sec. • B:•& P.C. for this reason
_.
S.M.I.
-
Grading
Driveway Enc.
Dare owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
hereby affirmAhat I have a certificate of consent to self -in -sure', or.a.certificate of
Vkdrker's Compensation Insurance, or a certified copy thereof: (Sec. 3800, Labor Code.)
Policy No: Company r,^r , 4.e r.
0 Copy is filed with the city.... ❑ Certified copy is hereby furnished.
TOTAL`
r
CERTIFICATE OF EXEMPTION FROMREMARKS
' WORKERS'COMPENSATIONINSURANCE
- -
(lois section need not be completed if the permit is for one hundred dollars^($ -1t00) valuation
ordess.) ........411 _�
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.as to become=subject_to the Workers' Compensation
Laws of California. �%�
".'_Date i ; : „Owner '<
NOTICE TO APPLICANT: If, after making this Certificate -of Exemption,you�should become
&L,blect to the Workers' Compensation provisions of the Labor Code, you must forthwith
campy with such provisions or this permit shall be deemed revoked.'
n
_ �c^' �� c}�' �t a �Y. �y,� q r r
f 1..� i f f S� S ill.. 1 143.49
ZONE: - - BY:
Minimum Setback Distances: -
Front Setback from. Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY.
1 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 Street Setback.f Tom Center Line
Side Setback from Property Line
Lender's Name
FINAL DATE' INSPECTOR •
Issued by: Date l2/21f 8Permit
Validated by:
Lender's Address
' This is a building permit when properly filled out, signed and validated, and is subject -to”
ex.31ration if work thereunder is suspended for 180 days.
(certify that I have read this application and state that the above information is correct:
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.
Signature of applicant Date
Milling Address
Validation:
Ci,r, State, ZiP
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
K KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
s 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
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a'c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING /2
FI L 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 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 APPJEQUIP.
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 /2
FI L INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL