05089 (SFD)• 4 4 "
P.O. BOX 1504
Building f 78-105 CALLE ESTADO
Address 54-587 Invetrnesls LA QUINTA, CALIFORNIA 92253
Owner
Address A?
City
Contractor
Address
City
State Lic.
& Classif.
Arch., Engr.,
Designer
Address
No. 08089
se Company BUILDING: TYPE CONST. - OCC: GRP.
t} ntr Ct ._ s n �Aa A.P. Number 8r_A L4%nt — VIVA t= 24A
Zip Tel. -
A�� Legal Description
Project Description 9Ams
Zip Tela
City
268130 Lic. # 328 Sq. Ft. 1918 No. No. Dw.
Size Stories Units "
Tel.
City I
Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 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.
! J
SIGNATURE - - - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,13rsiness and Professions ,Code: Any city or county which requires a
permit to constrict, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to lite a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation or Section 7031.5 by 'any applicant for a permit
subjects the applicant to a cIW 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
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 of completion, the owner -builder will have the burden
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-
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.)
D 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers 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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it 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, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
laws of California! . .
Dati 1 ) .1� Owner .t ._ ' t
NOTICE TO APPLICANT: If, after making..�this„Certftate of Exemption you should become
sufyect to the Workers' Corrpensation`provfsrons or Me 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.)
Lenders Name
Lenders Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that 1 have read this application and state that the above information is correct.
1 agree to comply with all city and county ordinances and state laws relating to building
s'construetion, and hereby authorize representatives -of! this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
New ❑ Add ❑
Alter ❑ Repair ❑
Demolition ❑
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
12/27/as
Issued by:
Date �ermit
Estimated Valuation
8132.816
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$ 442.73
Const.
515.50
Mech.
34.00 Y
Electrical
74.69
Plumbing
87.50
S.M.I.
9.28
Grading
Driveway Enc.
Infrastructure
$2,988.36
1,494. 1 8
Lear Credit
1.494.18
TOTAL
$2,657.88
-if ..''/7r�
REMARKS
j 724' {
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
12/27/as
Issued by:
Date �ermit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
rF-9—T FL. SO. FT. ® $
UNITS
SLAB GRADE
ROGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
FORMS
ER ORS IC
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ, Ff. ®
GA (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
T P. POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
WALL SO. FT.
WATER SYSTEM
DRINKING FOUNTAIN,
GRADING
cu. yd.
$ —Plus—X$—=$
URINAL
SO FT ®
FINAL INSP.
AMING (,1�/2
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
I+—z/
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® Vic
HOUSE SEWER
INSPECTION" ffw yu
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
ROGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER ORS IC
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GA (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
�VOKAS (FINAL)/
T P. POLE
GROUT
WATER HEATER
ICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ —Plus—X$—=$
LUMBER GR.
FINAL INSP.
AMING (,1�/2
FINAL INSP.
ROOFING
WK,
i
I+—z/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
G .FIREWALL
ING
MESH
INSULATION/SOUND
FINIS GRADING
INSPECTION" ffw yu
CERT. OCC.
FENCE FINAL
INSPECTOR S SIGNATURES/INITIALS
GARDEN WALL FINAL
t