003245 (SFD)Building
Address
Twit
44
P.O. BOX 1504
78-105 CALLE ESTADO
54-837 Invex ess LA QUINTA, CALIFORNIA 92253
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SIGNATURE - - DATE
�58-282�5,
Contractor
PERMIT-• AMOUNT - -
,.. permit to construct, alter, improve, demolish, or repair any structure, ' - 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 (8500). •. '-
• 0-1, as owner of the property, or my employees with wages as their sole compensation, will
-- - '
. Plan Chk. Dep'-. -
-
Plan Chk. Bal.. - � �i±i�' _ �g
_
Const. '
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
'.Address
- 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
.
Electrical 1A A
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.) _
City-
❑ 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
Zip
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.) - -
O I am exempt under Seca B. & P.C. for this reason
Tel.
Driveway Enc.
State Lic.
Date • owner
Infrastructure _ fflst�_O
City
& Classif.
288130
Lic. #
.28
Arch.;-Engr.;
TOTAL ft- . A A 71�
Designer
REMARKS
(This section need not be completed if the permit is for one hundred dollars (S 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 Owher
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become
subject to' the Workers' Compensation provisions of the Labor Code, 'you must. forthwith;Minimum
comply with such provisions or this permit shall be deemed revoked. -
No.. 003245
BUILDING: TYPE CONST. OCC.,GRP.
A.P. Number F GA [est
Legal Description
Project Description pian 31UR
Sq. Ft.: DING 305 No. No. Dw.
Size- - .626 -Stories' " Units
New ❑ Add ❑ Alter ❑. ' * Repair ❑- Demolition ❑
Address
Tel.
CityZip
State
_ ...
_
Lic. #
LICENSED CONTRACTOR'S DECLARATION '
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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
I hereby affirm that l am exempt from the Contractor's License Law for the following
,r reason: (Sec; 7031.5,Business and Professions Code: Any. city or.county which requires a
Estimated Valuation RA
� '
��
USTprior
PERMIT-• AMOUNT - -
,.. permit to construct, alter, improve, demolish, or repair any structure, ' - 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 (8500). •. '-
• 0-1, as owner of the property, or my employees with wages as their sole compensation, will
-- - '
. Plan Chk. Dep'-. -
-
Plan Chk. Bal.. - � �i±i�' _ �g
_
Const. '
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
.Mach. ' '
- 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
.
Electrical 1A A
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.) _
Plumbing
❑ 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
- -
S.M.I.
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.) - -
O I am exempt under Seca B. & P.C. for this reason
-
Grading
Driveway Enc.
Date • owner
Infrastructure _ fflst�_O
WORKERS' COMPENSATION DECLARATION
1 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 ft- . A A 71�
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE _
REMARKS
(This section need not be completed if the permit is for one hundred dollars (S 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 Owher
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become
subject to' the Workers' Compensation provisions of the Labor Code, 'you must. forthwith;Minimum
comply with such provisions or this permit shall be deemed revoked. -
ZONE: BY:
Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
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.)
Side Street Setback from Center. Line
Side Setback from Property Line -
Lender's Name
. FINAL DATE. INSPECTOR
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.
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.
Issued by: Date 7 1.17 In 7 Permit -
Validated by: 1
Signature of applicant —Date—
ateMailing
Address
Mail ' In
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ,.FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. 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 APPJEOUIP.
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ec
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBLTOTAL
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 APPJEOUIP.
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.
r FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL