002186 (RPL)P.O. BOX 1504 N o. 002186
Building 78-105 CALLE ESTADO '•
Address 90-35-5 ]Z BB=h LA QUINTA, CALIFORNIA 92253
Owner
Mailing* '
Address 75-005 Cbuntw Club D..
City Zip Tel.
ftsert 92260. 568-!-282V,,,
Contractor
Address
68-465 Femz RDad
' City ...... _ Zip , • Tel.' _
State Lic. I City
& Classif. 275796 Lic. # 69—
Arch.,
Arch., Engr:,
Designer'
Address Tel.
BUILDING: TYPE CONST. OCC: GRP: '
A.P. Number
Legal Description
Project Description Vim C
1 20.x 30 .. _
spa ID X 10
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑t . Add ❑ Alter ❑ 'Repair ❑ Demolition ❑
.....
POOL A
City
Zip
State
...
Lic. #F
:F;' ENCE
LICENSED CONTRACTOR'S DECLARATION
•
I hereby affirm that I am -licensed under Provisions of Chapter 9 (commencing with'Section
00)
• 70of Division 3 of.Uie Businessyannd Professions Codeand my license is in full force ander -
AL
effect. +�` ,/. *; ,,,i • i -Y'. civ'' r`..• r �•+.,.::.•-._..j.,.i t'
SIGNATURE DATE
_
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's. License Law for the following
Estimated Valuation .9
reason: (Sec. 7031.5,Business and Professions Code: Any city. or .county •which requires, a
permit to construct, alter, improve, demolish, of repair any structure, prior to its issuance also
-' - M-.•. "
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 or the'Susiness and Professions Code, or"that. he isexempttherefrom,- and the basis•..
for. the alleged exemption. Any Section 7031.5 by 'any -applicant for -a
._ -'
Chk.. Dep.•
violation of • permit
subjects the applicant to a'civil penalty of not more lhan'live hundred dollars ($500). ' ..
:Plan
_ -. . ..
Plan Chk. Bal.
0 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
Const. `34}s.i7i
Professions Code: The Contractor's License Law does not apply. to an owner of•properly, who
builds. or Improves thereon and who does such work himself or through his own employees,
Mech..."
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 14. "
of proving that he did not, build or improve for the purpose or sale.) , . - _ - ..
.•V
'
0 1, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing • �iG
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law -
does not apply to an owner of who builds or improves thereon, for
S.M:I. 14
properly and. who contracts
• such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
- . . +
-
'0
Grading
1 am exempt under Sec. B.-& P.C. for this reason
_
Driveway Enc.
Date Owner
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
0 Copy is filed with the city. . 0 Certified.copy is.hereby furnished. _-' ,
TOTAL 3iU •?
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 thg work for which this permit is issued, I shall not
- - -
employ any parson 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 or Exemption you should become
ZONE: BY:
subject to the 'Workers' C6thperisation 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
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.) - , „ - -
ine
Side Setback from.Property Line—
Lender's
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.
certify I have this
: • ^ . . ��
"'
.I .that read application and state that the above information is .correct.
' I agree
.'Issued by: Date, Permit
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. ,, f
Validated by:
Signature of applicant t r Date �'
Mailing Address - f.
Validation:
City, State, Zip
A4%..98. 3 17.y. 5...60.26 S1• -
' HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. Q. 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.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
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.
SO. FT. @ c
BATH TUB
SQ. 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.IEQUIP.
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 SIGNATURES/INITIALS
GARDEN WALL FINAL :1