002349 (RPL)r
i +
44
P.O. BOX 1504 No. '002349
Building 78-105 CALLE ESTADO
Address 49-222 AV=i& Vi ,:jtp LA QUINTA, CALIFORNIA 92253 ry
Owner
BUILDING: TYPE CONST. 'OCC. -GRP:
Mailing
Address.
4220 r�"!XEf A.P. Number
City Zip - Tel.
Ftlm DeMit:.. 922450 341-2955 Legal Description
Contractor Project Description
.Address . _
P,3. B= 787
City Zip Tel
Ram 92270 328,!-00802.. .
State Lic. City
& Classif.. 301278 C-53 Lic. # 571 Sq. Ft. 4 e No. No. Dw.
..
Size-' ' ' Stories - Units
Arch.,' Engr:,
Designer New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION,,, TA
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.
SIGNATUREi 1i ..y 7... ti DATE .. .. ..
' 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 of county_. which requires a
'
Rear Setback from Rear Prop. Line
permitto construct, alter, improve, demolish, or repair any structure,'pdor to.,its issuance also
requires the applicant forsuch 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 theiefrom, and the basis
INSPECTOR
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for .a permit
Plan Chk. Dep. ' -
" subjects the applicant to -a civil penalty of not more than 9ve'hundred dollars ($500). ..
Plan Chk- Bdl.
O 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.
Professions Code: The, Contractor's License Law does not apply. to an owner *of property who
Mech:.
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
Electrical'
of proving that he did not build or improve for the purpose of sale.) ..
❑ I,•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
-
does not apply to an owner of property who builds or improves thereon, and who contracts for
S.M.I.
-- such projects with a contractor(s) licensed pursuant to the Contractor's License Law:).
Gradin ig
. O I am exempt under Sec.B. 8 P.C. for this reason
Driveway Enc.
Infrastructure
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm'thal 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.'
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This. section need not be completed if the permit is for -one hundred dollars (S100) valuation
or'less.) .. .... -. _
. I 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
NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should become
subject to the Workers'' Compensation provisions of the Cabor Code, you mus( forthwith
comply with such provisions or this permit shall be deemed revoked. .
CONSTRUCTION LENDING AGENCY
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.)
s
Lender'Name
Lender's Address
This is a, building permit when properly filled out, signed and validated, and is subject to '
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply wilh'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 �% I�— ! ,� R,- do . a + Dale ` t f_
Mailing Address w f
City, State, Zip
HARD COPY
TOTAL
REMARKS
101,000.0
AMOUNT
52.32
. 80..50
.67
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
A5559
5 8 i 81..49 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES'
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. SO. FT.
WALL SO. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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 ® 1114 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
USE SEWER
REMARKS:
VENTILATION
PIPING
PERMIT FEE
PERMIT FEE
HtGAS
MIT 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
klt60UND. REINF. S
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
r ND BEAM L�� /
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL