BLCK (05674)Build ig 52-651 _;AVARRO
Address
Owner
(fitit 4 4Q�rw
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address �1,r
City Zip Tel-
T,c', —,-` ti I -)2253 0;19/15 4--`t..7�a
f�1 - n71wP lgT!ItPFR
Address
City lZip I Tel.
State Lic.I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zipf State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affiml 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.
St{:NATURF
OWNER -BUILDER DECLARATION
I her affirm that I am exempt from the Contractor's License Law for the following
reason_ [Sec. 7031.5,8vskwe%s and Professions Code: Any coy or county which regtdres a
permft to construct. after. Improve, damold^.h, or rushw any structure, prior to as Issuance also
requires We
appfcanf for such permit to No a signed staferumf Thal he c Tx arced pursuant to
the pmvmwarrs at the Conlractor'•s License Law. Chapter 9 (co mrrencing with Section 7000) of
aivfsioh 3 of the Business and Prnfessions Code, or that. he is exempt therefrom, and the basfs
lar the alleged examptkin. Any vfolahm of Section 7431.5 by any applicant for a permil
subjects the Bppfcant to a char penalty of not mare than rrm hundred dollars {S500).
F1 1, as owner of the property, or my employees with wages as Ihelr sole compensation, will
do the work, and the structure. Is not Intended or offered for sate- (Sec. 7044, Qltisness and
Professions Code: The Confractors Lfcense Law does not apply in an owner of property who
lwiAds or knproves thereon and who does such work hk melf or thymo his own ampinyees,
provided that such improvements are not rnlanded or offered for safe. 7, however, the buifdkrg
or irtpprovemenf is said w)lbn one yaw of convetfon, the owner --builder wig 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 contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. B. & P.C. for this reason
Date Owner
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 rat 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 refsuu in any manner so as to become subject to the Workers' Compensation
Laws of Cah ornia.
Date -Owner _
NOTICE TO APPLICANT: It, allor making this C...sir re Of Exemption you should become
subject to the Workers' Compensation provisions or Tho Labor Code, you must forthwith
comply will such provisions or this permit shall be doomed 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 it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above infolmatton is correct
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby author4ze representatives sof this city to enter the above•
mentioned property for inspection purposes.
Signature of applicant -Date-
Mailing
ateMailing Address
City, State, Zip
N J56?4
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Project Description STUCCO WALL: 4' 5,�
u r?rM r p�RCE a 171" X Com} r
TOTAL
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
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
i25/Q )
Issued by: Data Permit
Validated by:
Validation:
Estimated Valuation
n2 , 195,1
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
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
i25/Q )
Issued by: Data Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
$
UNITS
IST FL. SO. FT- ®
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT.
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT.
DRAINAGE PIPING
SQ
CAR P. - FT -
DRINKING FOUNTAIN
WALL SQ. FT.
URINAL
SQ. Ff. a
ESTIMATED CONSTRUCTION VALUATION 5
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
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
SETBACK
SLAB GRADE
FORMS
FOUND. REINF.
REINF. STEEL
GROUT
BOND BEAM
LUMBER GR.
FRAMING
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
GARDEN WALL FINAL
PLUMBING
GROUND PLUMBING
ROUGH PLUMB.
SEWER OR SEPTIC TANK
GAS (ROUGH)
GAS (FINAL)
WATER HEATER
WATER SYSTEM
FINAL INSP.
ELECTRICAL
UNDERGROUND
BONDING
ROUGH WIRING
METER LOOP
TEMP. POLE
SERVICE
HEATING & AIR COND.
A.C. UNIT
HEATING (ROUGH)
DUCT WORK
HEATING (FINAL)
FINAL INSP.
GRADING
FINAL INSP. cu. yd.
$ -plus-x$
REMARKS-
SOLAR
COLL. AREA
STORAGETANK
ROCKSTORAGE
OTHER APPJEQUIP.
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