04617 (MISC)1
4�4,7
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P.O. BOX 1504 1 Y
48-20 Vista IQ 78 105 CALLE,ESTADO
Building$
• Andress
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" `LA QUINTA CALIFORNIA 92253''
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r Owner . an4 Mrs'. .•'Howie . . a••
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BUILDIN& TYPE CONST. - OCC. GRP.
Mailing
Address 1swuer
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A.P. Number
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Legal Description
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•Contractor - e
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Project Description Sun Screen � 1
Address
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City.
Tel.
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'a.State Lic.
City
&�Classif.
Lic. #
Sq' Ft. No. No. Dw. i
Size Stories Units
I f.A"rch., Engr., •,
Designer ,
New ❑ Add ❑ Alter ❑ "Repair El Demolition ❑ rt
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Address
Tel.
*`City
State
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lZip
Lic. #
LICENSED CONTRACTOR'S DECLARATION
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hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
�+ 7000) of Division 3 of the Business Professions '
_
and Code, and my license is in full force and:
. -•
effect.
.DATE
SIGNATURE DATE
'
' OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the followingEstimated
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-Valuation ��ff +��yjCC Ada-
$17�
Y D.
reason: (Sec. 7031.5,Business and Professions Code: Any city or county 'which requires a
600
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
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repuires the applicant forsuchpermit to file a'signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law,' Chapter 9 (commencing with Section 7000) of
- ,PERMIT AMOUNT
.. Olvision 3 o/ the Business and Professions. Code,' or that. he is exempt therefrom, and the basis
for Any Section 7031.5 for
Chk.' Dep. '
,r the alleged exemption. violation o/ by any applicant a permit
subjects the applicant to a civil penalty of not more than live hundred dollars (8500).
]
-Plan
Chk. ®
d I, as owner of the property, or my employees with wages as their sole compensation, will
Plan Bal.
do the work,' and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
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.COr1St. ` G 4 V Q
"' Pio/essions Code: The Contractor's License Law -does not apply to an owner of property who
-
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r,-•± builds or improves . thereon and who does such work himself or through his own employees,
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"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. ... ... - - -
:• v �i oy proving that he did not build or improve for the purpose of sale.) . -
_ _ ••
• •^ O l,, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
struct.the'project. (Sec. 7044, Business and Professions Code: The Contractor's License Law—,
•
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''+ •.' does not apply to an owner of property who builds or improves thereon, and who contracts for ,
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'{� �• such projects with a contractor(s) licensed pursuant to the Contractor.'s License Law.)
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>-Grading
am exempt under Sec. B. 8 P Cfo this reason
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Eric.
Driveway En,I
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y ate�i st�f� `
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Infrastructure
Owner
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+WORKERS'
COMPENSATION DECLARATION
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Thereby affirm that I have a certificate of consent to self -insure, or a certi,icaie-of
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^ Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.).r
.
Policy No. Company
O. Copy is filed with the city. ❑ Certified copy is hereby furnished.
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TOTAL r4/ '
CERTIFICATE OF EXEMPTION FROM
REMARKS �..+
(This
WORKERS' COMPENSATION INSURANCE
section need not be completed i/ the permit is for one hundred dollars ($ 100) valuation I
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!I. or less.)
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j, I certify that in the performance of thgwork 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 '.,,.
..
-APPLICANT:.
NOTICE' TO If, after making - this Certificate of'Exemption Exem hon
i g " p ' you should become
ZONE: BY: -
,j ,subject to. the -Workers' Compensation provisions of the 'Labor., Code, you must forthwith''
comply with such-provisionsor this permit shall bedeemed revoked. - -
Minimum Setback Distances: -
- `
".f.,
- Front Setbackfrom Center Line
Rear'Setback from RearNop Line' '
`
CONSTRUCTION LENDING AGENCY . • .. - �I..
; Side.Street Setback from Center Line ' t
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.) t' 1 >
�°
Side Setback.from Property. Line
;Lender's .Neme
" "
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j Lenders Address
This Is a building • permit when properly filled out, signed and'validated, and is subject to`:
FINAL DATE ' INSPECTOR '
+.
' a expiration if,work thereunder is suspended for 180 days..
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a •. •.l,I certify that I have read this application and state that 'the above information is correct.
SSued by: - Date Permit
.hagree to comply with all city and county ordinances and state laws relating to building`
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construction; and hereby authorize representatives .of , this •city to enter the . above _ . '
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t mentioned property for inspection purposes.k• �. •k
-Validated by. �' r'
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+Signature of applicant Date • ` r
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+�Mailing Address
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Validation: f "
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WHITE FINANCE PINK' APPLICANTrGREEN BUILDING'GOLDENROD ASSESSOR S OFFICE HARD COPY :.FILE.
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT p: $
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. a
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FTat
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. fp
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT. 6
FINAL INSP.
WALL SO. FT. ra
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu. yd.
$ plus x$
_$
URINAL
SO FT a
FINAL INSP.
FRAMING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTONDISHI
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
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
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESID fg 1 V. c
SEWAGE DISPOSAL
SO.FT.GAR g 3/,c
HOUSE SEWER
'
FINAL INSPECTION
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 APP.IEOUIP.
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.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR -
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL