9849 (PLBG)Building 54-05:i OBRE OIN
Address
Owner
T4ht 4 aCP Qutqz
P -O- BOX 1504 N Q .
78-105 CALLE ESTADO r V
LA QUINTA, CALIFORNIA 92253 `
•
PAUL, E r RtVANDEZ
Mailing
Address SAME
City Zip Tel.
LA QUINTA. CA 1 922.53 534-263.'
Contractor
WATER EUILPER
Address
SAME
City Zip Tel.
BUILDING: TYPE CONST. OCC. GRP. -
A.P. Number
Legal Description
Project Description SEWFR ROCKUP
State Lic. City
&r Classif. Lic. #
Sq. Ft.
No. No. Dw.
Arch., Engr.,
Size
Stories Units
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
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
7Bg0) of Division 3 of the Business and Professions Code, and my license is in full force and
effect-
SIGNA1LItiE DATrt
OWNER -BUILDER DECLARATIONEstimated
Valuation
1 hereby affirm that I am exempt from the Contractor's Llee . Law for the following
reason: fSec. 7031.5.BusH7ess and Professions Cade: Any city or comfy which roquvres a
pemrk to construct, alter, Improve, demolish, or repair any structure, prior to Av issuance also
(egrrkas the applicant for such permit to 190 a signed statement that he is 8cansed pursuant to
PERMIT
AMOUNT
the provisions W the Contractor's License law, 'Chapter 9 (commencing wish Section 7000) of
Alvision 3 of the Business and Professions Code, or that he is exempt therefrom, and the basis
for the alleged exemption. Any vlalalron of Secffon 7031.5 by for
Plan Chk. Dep.
any applicant a pemid
m4ects the applkanf to a cm penalty of not more Than five hundred dollars (5500]-
I, a9 owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Bal.
o the work, and the structure Is not Intended or offered for sale. (Sec. 7044. Sulsness and
Cade: The Conlraef w's License Law does not apply to an owner of property who
Const.
brlds or Improves thereon and who does such work himself or through his own en440yees,
Mech.
provided that such improvamenls ora not intended or offered lar sale. 0, however, the burldhv
or improvemord is said wilhhn one year of compleltan, the owner -budder will have the burden
Electrical
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-
Plumbing
struct the project. (Sec. 7044, Business and Professions Code: The Contractors License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date _L_'` (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
7, 30• U0
CERTIFICATE OF EXEMPTION FROM
REMARKS
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 th# work for which this permit is issued, I shell riot
employ anyparson in any manner so as to become subject to the Workers' Compensation
Laws of California
Date - owner,
'NOTICE TO APPLICANT: if, alter malting Oft Celfillcafe of Exemption you should become
ZONE:
BY:
subwf to the Worimrs' Compensation provisions of the Labor Cade. you muaf forthwith
noi0py **h suchprpvrslens 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 Center Line
hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3007, Civil Code.)
Side Setback from Property Line
Lender's Name
Lenders Address
This is a building permit when properly filled out, signed and validated, and is subject to
FINAL DATE
INSPECTOR
expiration if work thereunder is suspended for 180 days.
1 certify that I have read this application and state that the above Information is correct
Issued by:
Date Perrnit
I agree to comply with all clty and county ordinances and state laws relating to buitding
construction, and hereby authorlr8 representatives sof this city to enter the above
mart iormd properly for inspection purposes,
Validated by:
Signature of applicant Date
Mailing Address._
Validation:
City, State, Zip
i CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SO. FT. ® $
h 2
ND FL. SQ. FT. ®
FOR. SQ. FT.
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT.
SO. FT.
ESTIMATED CONSTRUCTION VALUATION $
UNITS
iMOBILEHOME SVC.
POWER OUTLET
COLL. AREA
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH WIRING
FLOOR DRAIN
MECHANICAL FEES
ROCK STORAGE
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
-SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
OTHER APP./EQUIP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
TEMP. POLE
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Va c
SEWAGE DISPOSAL
L
SQ.FT.GAR ® 3hc
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 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
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
L
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SiGNATURESIiNITIALS
GARDEN WALL FINAL