BLCK (003132)P.O. BOX 1504
Building \ 78-105 CALLE ESTADO
Address I,,,,j- 42 WfV"0V-V—^ LA QUINTA, CALIFORNIA 92253
Owner
William Urer
Mailing
Address 52—II9 Shady -Lane
City Zip Tel.
coacialla 92236
�;691
Contractor
Aaaress ...
No. 0031.32.
BUILDING: TYPE CONST. OCC: GRP.-
A.R. Number 773-275-01'a-9
Legal Description
Project Description
City
-
Zip _ _
Tel:
...
State Lic.
& Classif.•
City
Lic. #
Sq. Ft.
Size
No. No. Dw.
Stories Units
Designer "
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
-. LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chaptei 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
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5, Business, and Prolessions Code:. Any city or county_ which requires a
permit to construct, atter, 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, of that. he is 'exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5. *by 'any applicant fora permit
`subjects the applicant to a'civil penalty of not more than'tive hundred dollars ($500).-
$500):❑ I, as owner of the property, or my employees with wages as their sole compensation, will
0
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 himselforthrough his own employees, •
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
of proving that he did not build or improve for the purpose of sale.) r!
❑•l, as owner of the property, am exclusively contracting with licensed contractors to con-
strucI. the project. (Sec. 7044, Business -and Professions Code: -The Contractor's License Law
does not apply to an owner of property who builds or .improvesthereon, and -who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
. ❑ I am exempt under Sec. B: & P.C. for this reason
Estimated Valuation
nq
- $' 9 ;
- PERMIT"
AMOUNT
-
Plan Chk. Dep.."
...
Plan Chk. Bal.
C011St„
3
Mech.-
Electrical
Plumbing
-
S.M.I. - -
•^ ..
Grading
Driveway Enc.
1�Date �ir�. ' owner 1✓�.�-�'-' �k -. >T._
Infrastructure
/ WORKERS' COMPENSATION DECLARATION
" 1 hereby affirm that' I have a certificate of consent'to self•ihsuie, 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.
TOTAL
4 ;A
REMARKS
-
�_ _. _ _ _ _ M i
I o
S+
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. '
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.) .
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 authorize representatives -ofthis city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address -
City, State, Zip
HARD COPY
T
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 6AMU• Permit
Validated by
Validation:_
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2 ND FL. SQ. FT. p
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP.IEQUIP.
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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.
/
REI F. ST EL (O �6 .
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
t
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 :d