003612 (RPL)4
P.O. BOX 1504 No. 003612
Building 78-105 CALLE ESTADO
Address 54-x825 Inverness LA QUINTA, CALIFORNIA 92253
Owner _
Mailing
°1 • ~ BUILDING: TYPE CONST: OCC: GRP.
Address Same A.P. Number P'GA
City Zip Tel.
Legal Description
Contractor
Project Description pool
Address. -
" City lZip ITel.
State Lic.
& Classif. 37
Arch:, Engr.;
Designer
uty
Lic. # Sq. Ft. No. No. Dw.
Size Stories Units' -
New ❑• Add ❑
Alter ❑ Repair ❑
Demolition ❑
Address
Tel.
0055 W 85604 02-00 80 iQ
employ any person in any manner so as to become subject to the Workers' Compensation'
Laws of California.
City
Zip
State
Lic. # -
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
'subject
ZONE: -
BY: '
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter (commencing with Section
7000) of Division 3 of the Business and Professions Code; and my license is in full force and
effect.
c7'
'
_SIGNATURE DATE
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following000
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 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 of not more than five 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, Suisness 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 or sale.)
O 1, 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.) -
0 I am.exempt under Sec. B. ti. P:C. for this reason
Estimated Valuation
' '
CONSTRUCTION LENDING AGENCY
- -
PERMIT -
-
-
- AMOUNT
- Plan Chk. Dep.. ...
-
.� s
-
Plan. Chk. Bal.
-
_
.
COr1St. -
Side Setback from Property Line
Mech.
�+
. 1.6 a 00
- Electrical
`� �.� '
Plumbing
14.00
S•M.I.
Grading
expiration if work thereunder is suspended for 180 days.
I certify that I have this
Driveway Enc.
,
Date Owner
Infrastructure
Date Permit
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
0.Copyis 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
construction, and hereby authorize representatives of this city to enter the above-.
mentioned property for inspection purposes.
Validated by:
TOTAL
REMARKS
Mailing,Address
-
I certify that in the performance of the work for which this permit is issued; I shall not
0055 W 85604 02-00 80 iQ
employ any person in any manner so as to become subject to the Workers' Compensation'
Laws of California.
i � j 10 GASH 1 MAL AL t 102.1Q
Date " ' Owner
- env
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
'subject
ZONE: -
BY: '
' to the Workers' Compensation provisions of the Labor Code, 'you must forthwith
comply with such provisions or this permit shall be deemed revoked. -
'
Minimum Setback Distances:
Front.Setback.-from. Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line "
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
FINAL DATE
INSPECTOR '
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 this
,
read application and state that the above information is correct.
I
Issued by:
Date 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
Mailing,Address
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. , SQ. FT. ®
CARP. I SQ. FT.
WALL SQ. FT. ®
SQ 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./EQUIP.
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.
SQ. FT. RESID ® 11/4 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.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./EQUIP.
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
unarm, i un a JIV YIN 1 Vncanm i 1ww,
GARDEN' WALL FINAL