002052 (SFD)T4hf
QUWA
P.O. BOX 1504 No. 49F° 2 f
Building 78-105 CALLE ESTADO
Address 5J—'0fj ;Wlfflida LA QUINTA, CALIFORNIA 92253
Mailing
BUILDING: TYPE CONST. OCC. GRP,
Address
A-P. Number
City
Zip
Tel.
Legal Description
Project Description
Contractor
r Tck_aT�l�'�
Address
P. C'. $cam[ 2288
City
Zip
Tel.
iY 1i io
.; 21 4i, rJM
State Lic.
& Classif. '
City
Lic. #
Sq. Ft.
No. No. Dw.
Size
Stories Units
Arch., Engr., -
Designer
New Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
_t6tali jaz lirte
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70111, of Divisions 3 of the Buslness 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,Busfaess and Professions bode: Any oily or county which regattas a
permit to construct, after, improve, orwwilsh, or repair any stmcium, prior to its issuance also
requires the applicant for such permff to file a sl hed statement that he is ,Peened pursuant to
rho provisions or the Contractor's License Law, Chapter 9 (commencing wilh Section 7000) of
Dimon 3 of the Business and Pnefemom Cade, or that he is exempt therefrom, and the basis
for the alleged exomptWn. Any vfofarion of Section 7031.5 by any applicant for a perrrtff
subincrs the appkcant to a civil penalty of not more than five hundred dollars ($500)"
El I, as owner of the properly, of my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Bussness and
Pralossfans Code: The Contractor's License Law dues not apply to an owner of property who
bt*ds or Improves thereon and who does. such work hfmseN or through his awn employees,
provided that such Improvemenfs are not infanded or offered for seta. If, however, the building
or irrtprovement fs sold within one year of a mpleNon, the owner -budder WA have the burden
of proving that he did not build or improve for rho purpose of sa(e.)
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep"
Plan Chk. Bal.
COr1St.
MBCh.
Electrical
Plumbing
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the prp)ect. (Sec. 7044, Business and Professions Code: The Contractor's Llcanso Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contraclor(s) licensed pursuant to the Contractor's License Law,)
❑ I am exempt under Sec. B. & P.C. for this reason
S.M.I.
Grading
Driveway Enc.
Date owner
Infrastructure
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.
TOTAL
00
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(dots section need not be completed if the permit is for one hundred dollars ($100) valuation
ar lass:)
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 ferthwirn
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
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 Cede.)
Side Street Setback from Center Line
Side Setback from Property Line
Lender's Name
FINAL DATE
INSPECTOR 31
Lender's Address
This Is a building permit when properly filled out, signed and validated, and Is subject to
expiration if work thereunder is soapended 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 counly ordinances and state Jaws relating to building
construction, and hereby authorize representatives got this city to enter the above-
rrentloned property for Inspection purposes"
Issued by:
Validated by:
Date Permit
Signature of applicant Data
Mailing Addrss
Validation:
A 4 2 1 0
2 18 1200 R
City, State, Zip
~
HARD COPY
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
FL. SQ. Fr, ®
> FL. SQ. FT. ®
I SQ. FT. ®
1. SQ. FT. ®
P• SQ. FT. ®
LL SQ FT ®
SQ. FT. ®
�IMATED CONSTRUCTION VALUATION
$
UNITS
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
$
WATER PIPING
TE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
ONCE DRYER
GARBAGE DISPOSAL
SCE UNIT WALL FLOOR SUSPENDED
ILAUNDRYTRAY
'NDLING UNIT CFM
KITCHEN SINK
'"ION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
;ESSOR Hp
POLE, TEMIPERM
LAVATORY
JG SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
I B.T.U.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
EATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
FEE
PERMIT FEE
PERMIT FEE
TOTAL FEES
MICRO FEE
MECH.FEE
PL.CK.FEE --JCONST.
FEE
ELECT. FEE
SMI FEE
PLUMB. FEE
STRUCTURE
SETBACK
SLAB GRADE
FORMS
FOUND. REINF.
REINF. STEEL
GROUT
BON) BEAM
LOMBER GR.
FRAMING
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SRARFC ARRESTOR
GAR_ FIREWALL
LATH I NG
M ESH
INSULATION/SOUND
FINISH GRADING
-INAL INSPECTION
'ERT.- OCC.
ENCE FINAL
�R�EN WALL FINAL
PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
//��
f'6ROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP,
FINAL)r
TEMP. POLE
WATER HEATER
SERVICE
FINAL INSP.
WATER SYSTEM
GRADING
cu yd.
$ plus x$ =$
FINAL INSP.
FINAL INSP.
REMARKS:
SI G N ATU R ESII N ITIALS