003507 (RPL)Building
Address
Owner
maning-
Address
City
Contractor
44
P.O. BOX 1504 No, 003507
78-105 CALLE ESTADO
. LA QUINTA, CALIFORNIA 92253
Zip ITel.
- 92253
fit-,4fi5 'Perry Road
Zip Tel..
State Lic.
& Classif. 2751
Arch., -Engr.,
Designer
Address
BUILDING: TYPE CONST. . OCC: GRP. '
A.P. Number PGA West
Legal Description
Project Description Pool Spa
1234 -
City -
Lic. # 69 Sq. Ft. No.
Size.-- - - Stories
New ❑
Tel.
City Zip State
Add ❑ Alter ❑
. .
-
Lic. #
Date Owner
LICENSED CONTRACTOR'S DECLARATION
10) by'affirm that I am licensed under provisioris of Chapter 9 (commencing with Section
e '
ffec t. of Division3 of the'Business and Professions Code, and myjlicense is in full force and
effec-: /'x '�•� '+,''`�
r
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
...reason:
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 Piotessions 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 notmore than five hundred dollars ($500)' -'
Q 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
Estimated Valuation
.
-
PERMIT
'
.Plan Chk. Dep.
Plan Chk. Bal.
Const.
Meth., -
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
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 . . -
Plumbing
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Strutt 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.) -
❑ I am exempt under Sec. B. & P.C. for this reason
Grading
No. Dw.
-Units
Repair ❑ Demolition ❑
r a..
AMOUNT
$ 91.32•
140.,50
16.00,
20.00
14.00
1.37
HARD COPY
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
O Copy is filed with the city. O Certified copy is hereby furnished.
_
TOTAL
.G`%r ^ v
CERTIFICATE OF EXEMPTION FROM
REMARKS
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 the work for which this permit is issued, I shall not
•-�
jj!><K;} , ,#,{1 � - ^ f! fnr, •. !if
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date - Owner "
NOTICE TO APPLICANT: ff, after making this Certificate of Exemption you should become
ZONE:
BY:
subject '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 read this
11/39/S
application and state that' the above information is correct.
I to
Issued by:
- Date ermit _
agree comply with all city and county ordinances and state- laws relating to building
t
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. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SO, 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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
AS (ROUGH) y
(/
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
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/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
UGH PLUMB. _
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK-
ROUGH' WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
AS (ROUGH) y
(/
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL