001970 (RPL)P.O. BOX 1504 No... 0 x.970
Building 78-105 CALLE ESTADO
Address49-500 Avinada Vi -ita LA QUINTA, CALIFORNIA,92253 _
Owner
Mailing BUILDING: TYPE CONST:
OCC: GRP. - '
Address P._,mw #$ A.P. Number
City Zip Tel.
3 ... 92253 ;5644-4315 Legal. Description -'
Contractor
i j •. :'�, • .~�
Project, Deseription
Address _
k.
P.10. 1593 • _ SPA
CityTip'
9sTel.' ..
Palm Deawt �61' _346-48,04- '
State Lic. City
& Classif: •. s Lic. # Sq. Ft: ' No.. No. Dw.
2d Size _ _ Stories Units .. ,
.. Arch., Engr.; r
" Designer. New t. Add ❑ Alter El - " Repair ❑ .-Demolition ❑` t�
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 " sy
7000) of Division 3 of the Business and Professions Code, and my.license is in full force and
.effect ,r>•r.` "_,... -fra
SIGNATURE DATE
- 1 - OWNER=BUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's'. License Law for the following EStlmated Valuation ��}��p '
reason: (Sec. 703 1.5, Business and Professions Code: Any�un
city*or coty, which requires a 2-0*9 30`'i� 0
permii,to construct, alter, improve, demolish, or repair any structure, prior•to its issuance also - - - - - t• -'
requires: the applicant for such permit to-file.a signed statement that he is licensed pursuant -to- - PERMIT - AMOUNT' -
..the provisions of the Contractor's License:1aw, Chapter.9 (commencing with Section -7000) o/
`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 . lora permit Plan•Chk: Dep. _ -
• . subjects the applicant to a civil penalty o/ not more than five hundred dollars (3500). - - _ - `
❑ I, as owner of the property, or my employees with wages as their•sole compensation, will Plan Chk. Bal.. _s'�z _
Y .do the work 'arid the structure is not intended or offered'for sale. (Sec:•7044,'Buisness and-
Professions
nd"
Profesr sions Code: The Contractor's License Law does not apply to an owner of •property. who . COr1St. 39.50
-
builds oimproves thereon and who does such work himself orthrough-his own employees, _ •
..provided. that such improvements ,are not intended or offered for sale: If, however, 'the- building .Mach..; -`�.w
or improvement is sold within one year of -completion, the owner -builder will have the burdenEIBCtrICal - a s <.�. '0,,
of proving that he did.not build or improve. for the purpose of sale.). - .�. -
- O I, as owner of the property, am exclusively contracting with licensed contractors to con- - Plumbing
struct the -project. (Sec: 7044.fl, Business and Professions Code: The Contractor's License Law . 0
does not apply to an owner o/ property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - -- - - _ ,
50
Grading
O 1 am exempt under Sec. B. & P.C. for this reason'
Driveway Enc.
Date Owner Infrastructure.
I*. ;. .
WORKERS' COMPENSATION DECLARATION "
'I' hereby'affirm that 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.
❑ Copy is filed with the city.. ❑ Certified copy is hereby furnished.',
TOTAL
CERTIFICATE OF EXEMPTION FROM- •a • REMARKS.�,;
WORKERS' COMPENSATION INSURANCE
(This section need not be completed:if i/ the permit is for one hundred dollars ($100) valuation
- . or less.) _ _
certify that in the performance of thp work for which this permit is issued;'rs all not
employ any person in any -manner so as to become subject to the Workers'' Compensation'
Laws of California.
Date -. . . Owner .
NOTICE TO APPLICANT: I/, after 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. _ _ r - • - - '
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.)Slde Setback from Property Line -
Lender's Name
Lenders Address FINAL DATE INSPECTOR
This is a' build ing permit when properly filled out; signed and validated; and,is subject to
expiration; ifwork thereunder is suspended for 180 days. 4 n 4f�04 •
I certify that I have read this application_ and state•that the'above information is correct. Issued by:'' Date '•i.& 3 Permit
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. * . Validated by:
Signature of applicant" +��'" Date
Mailing Address, f ., Validation:,
city, Slate, , zip I
A:-3850 1 1559,52 R
- -HARD COPY—
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
2ND FL. SO. FT.
POR. SO. FT. @
GAR. SO. FT. @
CAR P. 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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EOUIP.
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/ac
HOUSE SEWER
REMARKS:
VENTILATION
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./EOUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
GARDEN WALL FINAL