Loading...
003269 (SFD)Building Address Owner Mailing Address City Contractor P.O. BOX 1504 No, 003269 78-105 CALLE ESTADO City LA QUINTA, CALIFORNIA 92253 Tel.. Minimum Setback Distances: BUILDING: TYPE CONST. OCC: GRP. City Lic.4328 Sq. Ft. >v 2t Size • -, A.P. Number ,tsa^x 1�e.rriF Arch., Engr., _. Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Legal Description INSPECTOR Issued by: City Zip State Lic. # Project Description 'Irfl,.,..,. +a0aa r. , V11111 ., ...,-.•..e.,. �. .� y o .u.er� �y r.r r 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. ❑ 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 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. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemptidn 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 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.) Lender's Name Lender's 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 I have read this application and state that the above information is correct. I agree'to comply with all city acid 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, State, Zip HARD COPY TOTAL REMARKS �'�'r • S . W;q 4 (A' Ok 4414! <'71x` xt"!`)..M! 4 City Zip ._ Tel.. Minimum Setback Distances: State Lia & Classif. ��4„n,, City Lic.4328 Sq. Ft. >v 2t Size • -, No. No. Dw. Stories Units Arch., Engr., _. Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. INSPECTOR Issued by: 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. c_,.- ,., - . . - t A_ I f a, i _ SIGNATURE DATE OWNER -BUILDER DECLARATION 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, 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, Chapter 9 (commencing •.with Section 7000) of. Division 3 of the Business and Professions Code, or that. he is exempt tAerefrom, 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 of not more than rive hundred dollars ($500). 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 Professions Code: The Contractor's License Law does not apply to an owner of, property who , .builds .builds orimproves thereon and who does such work himself or through his own employees, 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 or 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 Contractors License Law.) ❑ 1 am exempt under. Sec.. B. & P.C. for this reason Estimated Valuation PERMIT - - ' AMOUNT �- - Plan Chk. Dep.: ' _ Plan Chk. Bal. - Const. Mech. _ Electrical - - �� • Plumbing+� , S.M.I. - �^% • Grading +, 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. ❑ 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 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. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemptidn 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 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.) Lender's Name Lender's 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 I have read this application and state that the above information is correct. I agree'to comply with all city acid 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, State, Zip HARD COPY TOTAL REMARKS �'�'r • Validated by: Validation: S . W;q 4 (A' Ok 4414! <'71x` xt"!`)..M! 4 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: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. SO. FT. ® CAR P. SQ. FT. WALL SQ. FT. ® SQ FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILtHOME 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.000L HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR --SUSPENDED 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. SQ. FT. ®c BATH TUB SO. FT. ®c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT.•RESID ® 11/a c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER REMARKS: GAS PIPING PERMIT FEE PERMIT FEE. PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE7�7s_� 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 APPJEQUIP. ' 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 INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE -FINAL .. . Imarcl iun a alumm1uncannl11ALa. GARDEN WALL FINAL .-r, .c I.•. t fes.