002335 (BLCK)F \ Qawa •
P.O. BOX 1504 No. 002335
5
Building 78-105 CALLE ESTADO
Address 53--296 ANI'Mlida Mont' -um LA QUINTA, CALIFORNIA 92253
Owner
Mailing
BUILDING: TYPE CONST. OCC: GRP. •
Address P.o.B=1,659
A.P. Number 774-4333*W1 and 002
Legal Description Lfts. I and 2
Project Description
City
1-aQui&-a
Zip
82253
Tel.
Contractor
Address
'City
Zip
Tela
State Lie.
City
& Classif.
Lic. #
Sq. Ft. ' No. No.
Size - g3 Stories Units
Dw.
- .
Arch., Engr., .. .. .. _
Designer
New Ox Add ❑ Alter ❑ Repair ❑
.
Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
3 ft y,2 �� ~
LICENSED CONTRACTOR'S DECLARATION - _
I hereby affirm that I am licensed under previsions of Chapter 9 (commencing with Section'
70 OO) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
I '
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
permit 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 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 ($500). •'
❑ 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
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
Estimated Valuation
Estimated
1
PERMIT - -
t-
AMOUNT _
• _
Plan Chk. Dep.. -
Plan Chk. Bal.
Const. '
2*4.AO
Mech.
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.) ,
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
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. S P.C. for this reason
y.
S. M. 1.
Grading
Driveway Enc.
Date ' Ownerlr a` �-•w�' -v-w�
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.
TOTAL
39,27
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE .
REMARKS
(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 person Wany 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.
ZONE: BY: '
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.) Side Setback from Property Line
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 180 days. - -
I certify that I have read this application aid state that the above information is correct. Issued by: Date 4-236 Permit
agree to comply with all city and county ordinances and state laws relating, to building
construction, and hereby authorize representatives sof this city to enter the above-
mentioned property for inspection pturposres'.j./ Validated by:
Signature of applican �` 1 �`%Jt"✓«� Dates
Mailing Address 1 r r ' Validation:
City, State, Zip t a(
A537'7 4 23 -39.27 S1
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING fcES ,.
IST FL. SO. FT. ® $
2ND FL. SO. FT. ®
POR. SO. FT. ®
GAR. SO. FT, ®
CAR P. SO. 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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
SO. FT. ® c
BATH TUB
BOND BEAM
SO. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR,
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
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 PLUMBINGil
UNDERGROUND
A.C. UNIT
COLL. AREA
91 -Ks LA13 GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
L//',,/4ORMS L �(
7S u
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
(FOUND. REINF.
//REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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
To
i�
6,)! U
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
inarc�. � vn a awnw i unc��m � iqw,
GARDEN WALL FINAL