BLCK (002169)P.O. BOX 1504 -No.002169
Buildingty2r�MeTdsVcr 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner _.
Ban=
Mailing
Address 43-576 Msh TObM St.
CityZip Tel.
ia kta .. 92 345.269$
Contractor
owmw/bld=
Address
`City .
BUILDING: TYPE CONST: OCC: GRP.
A.P. Number 773-305-009
Legal Description Wit is '
Project Description
State Lic. City
& Classif.Lic. #
Arch- Engr.;
Designer
Address Tel.
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 f
1 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 .
or improvement is sold within one year o% completion,, the owner -builder will have the burden
of proving. that. he did not build or improve for. the purpose of sale.)
L3 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.)' -
0 1 am exempt under Sec.- B. & P:C .for this reason
Date, r !' L�'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
p 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 anyperson in any manner'so as to become subject to the Workers' Compensation
Laws of California.
Sq. Ft. No.
Size , > 175 •11n. f1stories
New. 0, Add ❑ Alter ❑
3 f{
No. Dw.
Units.
Repair ❑ Demolition ❑
&lAng Van
NOTICE TO APPLICANT:r If, after making this Certificate of Exemption you: should become
ZONE:
stimated Valuation
S.20,625.00
' subject to the Workers' Compensation, provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
PERMIT '
AMOUNT
Plan Chk. Dep:..
Front Setback.from Center Line
Plan Chk. Bal.
25.02
Const.
38.5
Mech.-
ech.Electrical
Side Street Setback from Line
Electrical
Plumbing
work for which this permit is issued. (Sec. 3097, Civil Code.) '
S.M.I. ...
A
Grading
Driveway Enc.
Lender's Address
Infrastructure
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.
I certify -that I have this 'the above
read application and state that information is'correct.
I'agree
ISSUed by:
TOTAL
64,02
REMARKS
construction, and hereby authorize representatives' of this. city to `enter the above-.
NOTICE TO APPLICANT:r If, after making this Certificate of Exemption you: should become
ZONE:
BY: '
' subject to the Workers' Compensation, 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 Line
hereby affirm that there is a construction. lending agency for the performance, of the
-Center
work for which this permit is issued. (Sec. 3097, Civil Code.) '
Side Setback from. Property. Line
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.
I certify -that I have this 'the above
read application and state that 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 .,•r ff� ~
Validated by:
Signature of applicant �/ %J Date
Mailing Address A 1
Validation:
City, State, Zip— t !
A 4 7 0 2
3 11 64,b2 Sl
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND 0 L. SO. FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. SQ. 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.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
c
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 r��/-
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REIN STEEL �
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ plus x$
t
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
c
DEC
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
1 VM"J JIVI'IAI VMCJ/IIVII IALJ,
GARDEN WALL FINAL