003206 (BLCK)- I' . T4ty/ 4 4 Q"
Building
Address _ V.-
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Owner
Mailing '
Address 732 Uillie%ts qd.
City Zip
Tel.
20
Contracto r
r
Address
732 Ictilli Road
City. Zip
Tel,
p 2.?-1-121
��f�
State Lic.
City
& Classif. 3 7934
Lic. # 7�r�
Arch., Bngr-,
Designer
Address Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
f hereby zf f irm that I am licensed under prOVl5lon5 of Chapter 9 (commencing with Section
7f1001 of Division ton 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGIN&UARF D.1.
OWNER -BUILDER DECLARATION
I hereby affkfn that I am exempt from the Contractor's Llcense Law for the following
reason: [Sec_ 703l.5,8usnass and Professipns Cade: Any city or county which requires a
permit to construct, after, improve, demolish; or repair any structure, prior to its asumce also
requires the aPpitant for such permit to No a signed statement that he Fs licensed pursuant to
the pw islons of rtro Contractor's License Law, Chapter 9 (commencing with section 7000) of
Divrsion 3 of the SaVuess and Afofessiuns Code, or that. he Is ex®mpt thereham, and the basis
/of the allepeA exemption. Any viotafton of Section 703L5 by any appltcanf for a permit
subjects the appficanl to a civil penally or not more than live 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. Butsness and
Piolessions Code: The Contractor's Lrcanso Law does nor apply to en owner of properly who
Wfds w fmproves thereon and who does such work hrmsetf or through his own employees,
provided that such knprovaments are not lntendad or offered for safe, fl, however, the bulfdrtg
or improvement is sold w4hfn one year of cwnplatfort, fha owner -builder will have the burden
of pwvtng that he did not bulky or impiove for the purpose of safe.)
❑. 1, as owner of the properly, am exclusively contfacting with licensed contractors to can•
struti the project. (Sec. 7044; Btfsirress and Professrans Code: The Contractor's License Law
does nor apply to an owner dr property who builds or impfovos thereon, and who contracts for
such projects with a conlra010,10 licensed putsuanf to the Conlraclor's Ltconse Law_)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date 1 Owne r
✓1
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. (Sac. 3800, Labor Code.)
Policy No- Company
[JCopy 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 pema is for one hundred dollars (ST00) valuation
or less.)
I certify that in the performance of Ihg work for which 'his permit is issued, I shall not
employ any ps.rsan In any manner so as to become subject to the Workers' Compensation
Laws cF Calitornia.
Date Owner
N017CE To APPLICANT N, after making this CarttPcare of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such Provhdons 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 far 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 -of this city to enter the above -
mentioned property for Inspection purposes.
Signature of
Mailing Adds
City, State,
ISO. 0032g,
BUILDING: TYPE CONST- OCC. GRP
A.P. Number 74--302--M6-.V
Legal Description
Project Description i 50' Petalm jng Wall 41 yflr+
Sq. Ft. No.
Size Stories
New ❑ Add ❑ Alter ❑
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
No. Dw.
Units
Repair ❑ Demolition ❑
ZONE: BY;
Minimum Setback Distances:
Front Setback from Center Line;
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
FINAL DATE
Issued by: —
Validated by:
Validation:
Side Setback from Property Line
INSPECTOR
Date Perm
AMOUNT
HARD CO
NO. ELECTRICAL FEES NO.
PLUMBING FEES
CONSTRUCTION ESTIMATE
UNITS
—
1ST FL. SO. FT. ®
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
2$
MOBILEHOME SVC.
BAR SINK
POR. SO' FT' ®
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
DRAINAGE PIPING
CAR P. SO. FT. @
DRINKING FOUNTAIN
WALL SO. FT' ®
URINAL
SO. FT.
WATER PIPING
ESTIMATED CONSTRUCTION VALUATION
$
FLOOR DRAIN
NOTE: Not to be used as property tax valuation
WATER SOFTENER
MECHANICAL FEES
SIGN
WASH ER(AUTO)(DISH)
VENT SYSTEM FAN EVAP.COOL
HOOD
GARBAGE DISPOSAL
APPLIANCE
DRYER
LAUNDRYTRAY
FURNACE UNIT WALL FLOOR
SUSPENDED
KITCHEN SINK
AIR HANDLING UNIT
CFM
TEMP USE PERMIT SVC
WATER CLOSET
SYSTEM
B.T.U.
POLE, TEMIPERM
LAVATORY
R HP
EEATING
AMPERES SERV ENT
SHOWER
TEM FORCED GRAVITY
SQ. FT. ®c
BATH TUB
B.T-U.
WATER HEATER
SQ FT ® c
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
MAX. HEATER OUTPUT, B.T-U.
SQ.FT.GAR ®3/<c
HOUSE SEWER
GAS PIPING
EE�EE
PERMIT FEE
EE
PERMIT FEE
PERMIT FEE
MICRO FEE MECH.FEE
PL.CK.FEE CONST. FEE
ELECT. FEE
SMI FEE PLUMB. FEE
DBL TOTAL FEES
PLUMBING
ELECTRICAL
HEATING & AIR COND.
SOLAR
STRUCTURE
PLUMBING
UNDERGROUND
A.C. UNIT
COLL, AREA
SETBACK
GROUND
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
SLAB GRADE
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FORMS
7
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF
GAS (FINAL)
TEMP. POLE
REINF. STEEL
WATER HEATER
SERVICE
FINAL INSP.
OUT
BEAM j
WATER SYSTEM
GRADING
�.. ND {
FINAL INSP.
cu. yd.
LUMBER GR.
FINAL INSP.
$ plus
x$ =$
FRAMING
REMARKS:
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIG NATURESANITiALS
GARDEN WALL FINAL