001967 (RPL)n/
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 49-312 Avenida ViSta ' ita LA QUINTA• CALIFORNIA 92253
Owner _
Mailing:
Address P.O. B= 780
City Zip
rifibka 92253
Contractor
�fltt�
Address
Tel.
'"1315
BUILDING: -TYPE CONST. 'OCC: GRP.
A.P. Number / `�'�• K { ' > <J ° .
Legal Description
Project Description
-P.O. Esus 1593
SP,L�f
.Minimum Setback Distances: ,
City .. _
,P imt
Zip .
92263
Tel
346-4.8414
Rear Setback from Rear.Prop. Line
State Lic.
City
Side Setback from Property Line
& Classif, 320445
Lic. #
Sq. Ft. No.
No. Dw.
' -
Size- Stories -
Units -
EngT., .. ..
Designer
Designer
Newel. Add ❑ Alter ❑
,
Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. # _
• _ LICENSED CONTRACTOR'S DECLARATION .
r• 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. r : r . t" .. .. - -•
_
SIGNATURE7, DATE
' OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
(Sec. 7031,,5,Business and Professions Code: Any city or'courty which requires a-
• permit_ to construct,, alter; improve, demolish, or repair any. structure, prior to its- issuance .also
.requires the applicant: for such permit. to file a signed statement that, he is licensed pursuant to
the provisions of the Contractor's License Law, Chapterr.9..(commencing with Section 7000) of.
' Division3*of the Business -and Professions Code, or.thet::he is -exempt therefrom,. and the'basis'
for the' alleged exemption. Any • violation of Section 7031.5. .by 'any applicant for. a permit .
subjects the applicant to a civil -penalty or not more than five hundred dollars' (3500). ' .
. ❑ 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
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 or completion, the owner -builder. will. have the burden
- of proving that he, did not build or improve for the purpose of sale.)
EstimatedValuation
$reason: ,P
-
--•PERMfT • -
•• ,.
- AMOUNT
-
Plan Chk. Dep..
Plan. Chk. Bal.
9
25.0.2 -
Const. -
�• C�
'30/•,50
Mech. - -
-
17.50
_
Electrical
Plumbing
14.00
❑ 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.) • -
..O. I am exempt under Sec. � - B. 8 P.C.'for reason �
_
S.M..1. - ••
�,
Grading
Driveway Enc.
- -
' Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have *a* certificate of consent to self -insure, ora certificate of
Worker's Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ 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 '($100) 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 Labor Code, you must ''forthwith
comply with such provisions or this permit shall be deemed revoked.' -
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work'for which this permit is issued. (Sec: 3097, Civil Code:) .
Lender's 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 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
Mailing Address
City, Slate, Zip 7
HARD COPY
TOTAL
REMARKS,.
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!2--30-8 Permit
Validated.by:
Validation:
A 3 8 4 8
1 15 59,5.2 Ch.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT. ®
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SD. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT. ®,
OTHER APP.IEQUIP.
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
BOND BEAM
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LATHING
SQ.FT.GAR ® 3/ac
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
INSULATION/SOUND
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
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
1
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
mz)rrciunawt mAiuntanmi1ALb.
GARDEN WALL FINAL