001786 (SFD)1
4
P.O. BOX 1504 N o.• 001786
Building 78-105 CALLE ESTADO
Address 55-045 DM'= LA QUINTA, CALIFORNIA 92253
Address 3 75-605 C 1.1'y CU
City JZip9226().JTel..6Vrt.Palm �-2$28
Contractor
Address
al�l�
City' Zip` Sam Tel.
State Lic. I City
& Classif. Lic. # 328
-Arch., Engr. .
Designer ���•
Address Tel.
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description pm vwr PM SQ 0
Sq. Ft. No. No. Dw.
Size • Stories- Units
New R Add ❑
2$15- I- M11 Ave.
(714), 540-517
REMARKS'
CityZip
MSta- �
..9262
State
Lic. # �.
//
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed -under provisions of Chapter (commencingg ith,Section
7000) of=Division 3 of the Business and Professions Code, and my licceensse,!§ m, u11 -force and
_effect: �' . ^��/-'.`�1i•/ �. �/ / ,�' .%'�,'_S
't
+
ZONE:
DATE
Minimum Setback Distances:
OWIJER•BUILDER DECLARATION
I hereby affirm thatI 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, after, improve, demolish, or repair any structure; prior to its Issuance also
„ requires the applicant for such permit to rile 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 penally of not more than five hundred dollars ($500).
O 1, 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 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
orimprovement 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, 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 contractors) licensed pursuant to the Contractor's License Law.) -
❑ I am exempt under Sec. B. 8 P.C. for this reason
Front Setback from Center Line
Estimated Valuation
'
+r
PERMIT • l
Plan. Chk.Dep.•.
Plan Chk. Bal. .
�.
Const.
Mech.
Electrical
Plumbing
S.M.1.
Grading
Driveway Enc.
Date owner I Infrastructure
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
❑ 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 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
Laws of California.
Date Owner
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
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 and county'ordinances and state laws relating to building
construction, and hereby authorizerepresentatives of .this city to enter the atiove�
mentioned property for inspection-,purposes.'K .
Signature of applicants--` �� 3� kr L `� Date_
Mailing Address i i / i'
City, State, Zip i
HARD COPY
Alter ❑ Repair ❑ Demolition ❑
V
.Of
178,307.00
AMOUNT
5529§1100
630.50
55.00
X121.71 '
136.50
36.35
2,000.00
TOTAL
3,485.17
REMARKS'
.�V\XLt �'#ALF aAk ki. S:aM1.+'; i•3:wi "d6>L}4i.hY YJI:Ja`d�- .\
RD MOM M=
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:
A3179
.1 .1 •13 348,17_. CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FFAII&NO.
PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. ` SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SO. 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUG )
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER -,
DUCT WOR
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
SO. FT. ®c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP
ROOFING
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
rGROUND PLUMBING /,2
UNDERGROUND
A.C. UNIT
COLL. AREA
uAB GRADE �a �(�
ROUGH PLUMB, 6
BONDING
HEATING (ROUG )
STORAGE TANK
FORMS ' rp2
SEWER OR SEP
ROUGH WIRING -2
DUCT WOR
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP a
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 7
�[
FINAL INSP
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUN
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL,
INSPECTOR'S SIGNATURES/INITIALS
GAI DEN WALL FINAL