002393 (SIGN)T'r�' 414 QuG�tw
Building
Address 7S -i2.1 AVenida La Fbnda
Owner
Ncniq l4i $3,ex=
Mailing.
Address
City Ta Quifta. Zip Ti
Contractor
aw*--/bldw .
Address.
..City .... _ .
State Lic.
& Classif.
Zip Tela
City
Lic. #
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. -
A.P. Number 769'"262-026
Legal Description
Project Description
Sq. Ft.
Size
No.. 002393
OCC: GRP.
crr-site f �qn, a3 pm M.
No.
Stories
No. Dw.
Units
Arch., Engr.,
Designer
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition ❑
Address
Tel.
Rear Setback from.Rear Prop. Line
Side Street Setback, from Center Line
City
Zip
State
.
'
Lic. #
Date. Permit
Validated by:
LICENSED CONTRACTOR'S DECLARATION
Validation:
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....
_
A5%3%
_SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the followings
reason: (Sec. 7031.5, Business. and Professions Code: Any city• or county which requires a
' permit to construct, after, 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
Estimated Valuation
'
PERMIT
AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
r- '
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
Plan Chk. Dep..
._.
- . subjects the applicant to a civil penalty of not more than five hundred dollare($500).
O I, as owner of the property, or my employees with wages.as their sole compensation, will
Plan Chk. Bal.
COrISt.
+��
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
Mech.
-
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 of completion,'the owner -builder will have the. burden
of proving that he did not build or improve for the purpose of sale.) ' . -
Electrical -,d.Q
..o
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
S.M.I.
_
'
50
w
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
Grading
Driveway Enc.
Date Owner s� ti I i
Infrastructure
r
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self:insure, ora certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. , O Certified copy is hereby furnished. '
TOTAL
25.50
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 in any 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.
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 buildingpermit 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 -of this city .to enter the above-
mentioned property for inspection purposes.
Signature of applicant t( f Date
Mailing Address ` •�
City, State, Zip
HARD COPYI
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. Permit
Validated by:
Validation:
A5%3%
6 5 2650 R
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL.' SQ. FT. ® $
2ND FL. SQ. FT.,®
POR. SQ. FT. @
GAR. SQ. FT. ®
CAR P. SQ. FT.
,WALL SQ. FT. @
r SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET .-
J
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS.
DRAINAGE PIPING
DRINKING FOUNTAIN «
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
r SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL '
FURNACE UNIT :WALL FLOOR SUSPENDED
I
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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 i
SQ. FT. ®'c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL M
_ �//�j/� (%%%%)
-�
'
SQ.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
;TOTAL FEES
: MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE JELECT.FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. I 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
1�FOUND. REINF.
i
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
1 GROUT
WATER HEATER
RVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
r
FINAL INSP.
ROOFING
_ �//�j/� (%%%%)
-�
'
REMARKS:
VENTILATION
FIRE ZONE ROOFING
•r
I FIREPLACE
`-SPARK ARRESTOR
', GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
'
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
-FENCE FINAL
INSPECTOR'S SIGNATURES11NITIALS,
GARDEN WALL FINAL