BLCK (003029)4
P.O. BOX 1504
Building51-•910 AVCni � HA � 7&105 CALLE ESTADO
Address LA OUINTA, CALIFORNIA 92253
Owner
John J. PLS•
Mailing
Address U-910 Avenida Vaiarra
City Zip Tel.
La Qainea 1:2253 564-4186
Contractor
fa��.et�ar
Address
City Zip . Tel..
State Lic.
& Classlf.
Arch., Engr.,
Designer
Address
Lic. #
No. 003029
BUILDING: TYPE CONST. . . OCC: GRP.
A.P. Number
Legal Description
Project Description 'W11
l111,64 fie
Sq. Ft. i55oNo. No. Dw.
Size Stories Units
New E� Add ❑ Alter ❑ ' Repair ❑
City Zip State
- Lic. #
LICENSED CONTRACTOR'S DECLARATION -
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license Is In full force and
effect..
SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated V81U3tit
I hereby affirm that I em exempt from the Contractor's License Law.for the following
reason. (Sec. 7031.5,Buslness and Professions Code: Any city or county which. requires e
Demolition ❑
permit to construct, alter, Improve, demolish, or repair any•structure, prior to Its issuance also
requires the applicant for such permit to lila a signed statement that he Is. licensed pursuant. to'
the provisions o/ the Contractor's License Lew, Chapter 9 (commencing with Section. 7000) o/ .
Division 3 of the Business and Professions Code, or thef. he Is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any.appllcant for a permitPlan
subjects the applicant to a civil penalty of not more then 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, Bu/sness and
Professions Code: The Contractor's License Law does not apply to an ownerofproperty 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. d, however, the building
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.) - _.
PERMIT
s••
AMOUNT
Chk. Dep. .
Plan Chk. Bal.Palo
-110
Const.
OnS.
.!2f1
Mech.
-
Electrical
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 contracfor(s) licensed pursuant to the Contractor's License Law.)
f ❑ 1 am exempt under Sec. B. & P.C. for this reason
S.M.I. •.
.. r
Grading
Driveway Enc.
Date - Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
Ihereby 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 flied with the city. ❑ Certified copy Is hereby furnished.
TOTAL
i2f1
REMARKS
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 pperson in any manner so as to become subject to the Workers' Compensation
Lowe of Cellf0rnla.
Data Owner
NOTICE TO APPLICANT: 11, 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
Ihereby 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 Street Setback from Center Line
Side Setback from Property Line
Lender's Name
FINAL DATE
ISSUed'by:
Validated by:
INSPECTOR
>*
Date Permit
Lender's Address
This Is a bullding permit when properly filled out, signed and validated, and is subject to
expiration It 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 authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
A 7 6 7 3
4 3 3b80 fl
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. 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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAS (ROUGH)
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
WATER HEATER
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
BOND BEAM
SO.FT.GAR ® 3/ac
HOUSE SEWER
GRADING
cu. yd.
$ -Plus-X$-=$
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 APPJEOUIP.
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
DEC
' 7 19 VY
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL