001972 (RPL)914W
P.O. BOX 1504 No. 001972•
Building78-105 CALLE ESTADO
Address 49-520 Mod& iata3 Btmita LA QUINTA, CALIFORNIA 92253
Owner
Mailin BUILDING: TYPE CONST: _ 5-�rOCC: GRP.
Address -M
�•• A.P. Number
City Zip Tel. I t
. TA _0AX_*A 92253 —.035 Legal Description - 3
Contractor _
. Project Description
Address- ..
SPA
City . , Zip .... .. Tel.-
92251 346--4804
State Lic. City
& Classif. 320445 Lic. # Sq. Ft. No. " No. Dw.
_
Size • Stories Units
Arch:, Engr.,.
Designer New Q Add ❑ Alter ❑ Repair ❑ - Demolition ❑
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
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect. _
SIGNATURE ' 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 or. county. which requires a- - -�• -
permit to construct, alter, improve, demolish, or repair -any structure, f. prior to its issuance also + -
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 Law, Chapter 9- (commencing with Section 7000) of
Division 3 of the Business and Professions' Code, or that. he is exempt therefrom, andthe basis
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 five hundred dollars ($500),
❑ I, as owner of the property, or my employees with wages, as their sole compensation, will , Plan Chk. Bal... 25.0 .2
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and �^' C- nst. $ '
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, Mech. : ,,'► fj�
provided that' such improvements are,not intended or.offered for sale. If, however,: the building e ,
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 o/ sale.) ^
O 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing JA al3L�
-struct the project. (Sec. 7044, Business and Professions Code: The Contractor'sLicense 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.) .50 -
Grading
O 1 am exempt under -Sea B. & P.C. for this reason
Driveway Enc.
Date, Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
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.,_ O Certified copy is hereby furnished..
TOTAL qq�+gy d�
_ "CERTIFICATE OF EXEMPTION FROM REMARKS ISO 52.
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 thg work for which this permit is issued, F 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, alter 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.
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.) Side Setback from Property Line.
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated,'and is subject to FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 180 days.6
I certify that I.have read this application and state that the above informationis.correct. Issued by: Date 6 —8Q-5
Permit
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 f, t
Mailing Address AN 'Validation:
City, State, Zip
..A3852 1 15 a 59.52. _CK.
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. SQ. FT.
WALL SO. FT. ®
SO. FT, ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
I 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.IEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 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.IEQUIP.
REINF. STEEL
GAS (FINAL) L _ri�
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
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL