001896 (SFD)P.O. BOX 1504 No. 001896
Building 78-105 CALLE ESTADO
Address 54-973 SwMrreS5 LA QUINTA, CALIFORNIA 92253
Owner
Mailing
BUILDING:. TYPE CONST. OCC..GRP.
Address 75-005 Mtn M A.P. _Numb_ er
City Zip Tel.
'-Da�. 92260 .568-2U8 Legal Description
Contractor Project Description
_ . Address.
SWIM
City Zip TeI:
Sam
State Lic. City UM 3.42
& Classif. Lic. # 328 Sq. FtNo. No. Dw.
Size { U Stories Units
-Arch., Engr.,
Designer Rabift-t Jdtave= ASW--` NewZ Add ❑ Alter ❑ Repair ❑• Demolition O
Address Tel.
2915`rbd EM Ave. (714) 540-6U .
City Zip State
Mitta M 92626 Lic. #.
r lqQ NSED.CONTRACTOR'S DECLARATION
I hereby affirm:that I am licensed under provisions of Chapter 9'(commencing withctibn
7000) of- Division 3 of the Business, and Professions Code, and my license is in full force and....+ • '
effect.. _Y'
_SIGNATURE i I / d' DATE -
rr'
OWNER -BUILDER DECLARATION %
I hereby affirm that I am exempt from the Contractor's License Law for the following' Estimated Valuation
reason: (Sec. 7031.5,Business and Professions Code:. Any' -city or county .which requires a 197#34%,N
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also v
requires the applicant for such permit to file a signed.statement that he is licensed pursuant to _ PERMIT AMOUNT
-
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 Plan'Chk.. Dep..'
subjects the applicant to a civil penalty of not more than five hundred dollars (8500): •
0 I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk.,Bal. ? •�
do the work, and the and is not intended or offered for sale. (Sec. 7044, Buisness and COnst. ' 'j Q.�
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, Mech. r 5540
.. 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 Electrical 128.65
- of proving that he did not build of improve for the purpose of sale.) t
O I, as owner of the property, am exclusively contracting with licensed contractors to con. Plumbing - 140.50
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 S.M.I.•$12
such projects with a contractor(s) licensed pursuant to the Contractor's License -Law.) - -
❑ I am exempt under Sec.- - B. 8 P.C. for -this reason Grading
Driveway Enc.
Date Owner Infrastructure 2,000.00
WORKERS' COMPENSATION DECLARATION
hereby affirin 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 3,583.17
CERTIFICATE OF EXEMPTION FROM - REMARKS
WORKERS'.COMPENSATION INSURANCE ..- --
(This section need not be completed if the permit is for one hundred dollars (8100) valuation q1AAIIJ IENW—U 01 AIL ♦14.Y.6. aSY 7 CJW" .4.&IL
or less.) -• - -
I certify that in the performance of the 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 Wtnr�L�t 1 y
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption youshould become ZONE: BY:
"subject to the Workers' Compensation provisions of the Labor Code, you must forthwith ,Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. -
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) 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. 11,12—or.
I certify that I have read this application and state that the above information is correct: %Issued -by: Date Permit
I agree to comply with'all city and county ordinances and state laws relating to building
construction, and hereby authorize; representatives -of this 'cityto enter the above
mentioned prop erty for inspecli .purposes. �= !, r •_,.Validated by:
Signature of applicant % �"=-�.A-G- 7 Date
r •i*t 1.-� )
Mailing Address i t w s / Validation:
City, State, Zip
/ A3188 11 13 358u17 CK
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FE
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2N0 FL. _ SQ. FT.
POR. SQ. FT. ®
GAR. SQ, FT. ®
CAR P. I SQ. FT.
WALL SO. 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
WASH ER(AUTO)(DISH).
APPLIANCE DRYER
GAS (ROUGH)
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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SQ. FT. ® c
BATH TUB
FINAL INSP.
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR Q 3/ac
HOUSE SEWER
VENTILATION
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/e?//IS
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE , 3 8
ROUGH PLUMB.3
BONDING
HEATING (ROUGH
STORAGE TANK
FORMS
SEWER OR SEPT
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.� S
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. FIREWAL
LATHING
MESH
INSULATION/SOUND 3 /
I
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL