12011 (RPL)m TWIVI 4 4 Qakm
a
5-1-ZZo P.O. BOX 1504 N 0.
Building- 78-105 CALLE ESTADO
Address _- P -- _t. LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. OCC. GRP.
Address 2 ? 9'- Nv E:'?ta r- 6
City Zip Tel.
399-7646
Contractor
Address
3 -:3O
City Zip Tel.
State Lic. city I �
& Classif. C 5 6S ) q L:j?; `LIC.40
Arch., Engr., - -- -
Designer
Address I Tel.
CityZip I State
I I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed -ander prbvislons of Chapter 9 (commencing with Section
7000} of Division 3 of the Busihess and Profe831ons Code, and my license is in full force and
of fact.
SIGNATL1tiE y DATE
r
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License law for the following
reason: [Sec: 7031.5,Rvs1nass and Prelessions Coda. Any city or county which requires a
pormt! 10 construct, atter. Improve, demoltsh, or repair any structure, poor to Its Issuance also
llrllas the appticant for such pariah to file a signed sfulamenl that he is ikensed pvtvwlnt to
the ora vis ions of the Contractor's License Law, Chapter 9 (commencing w4h Section 7000) or
1N�fston 3 or the Business and Professions Cade, or Thal he Is exempt therefrom, and the basis
tot theaHegad exemption. Any violation of Section 7037.6 by 'any applicant for a permit
§ubjncls the ftcanf to a ciw7 penalty a! nql more than five hundred dollars (3500).
❑ 1, as owner of the properly, nr my employees with wages as their sole compensation, will
do the work, and the structure Is not Intended or offered for sale. (Sec_ 7044, 8105`7095 and
Profess}ams Code: Tha Contractor's License Lew does nor apply to art owner of property who
builds or knoraves thereon and who does such work himself or through his awn employees,
provided that such fmpravements ars not Intended or petered for sale. if, however, the building
or Improvement is sold within one yoar of completion, the. ownar-hulider wyl have the burden
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-
struct the project. (Sec. 7044, Business and Prulassions Coda: The Contractor's la'conuo 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.)
❑ 1 am exempt under Sec. B. & P.C, for this reason
Date 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.)
Pot icy. Nn. Company
I py Is filed with IN city. n Certlfiett copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
{ibis section need not be completed if the permit is for one hundred dollars ($100) valuation
ar less.)
I certify thatin the performance of the work for which this permit is issued, I Shall not
employ any person in any manner so as to become subject to the Workers' Comp@nsation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, allot maA*rg this Cartrrtcare of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions W IN,% permit shall be doomed 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 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 alt city and county ordinances and.state laws relating to building
construction, and hereby authorize representatives sof this city. to enter theebove.
mentioned property for Inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
A.P. Number
Legal Description
Project Description
1261.
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation 1 3
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. 9 Aa
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
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:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL.
2ND FL.
POR.
GAR.
CARP.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. ® $
SQ. FT.
SO. FT.
SQ. FT ®
SQ. FT.
SQ. FT. @
SQ. FT. @
VALUATION $
UNITS
YARD SPKLR SYSTEM
'MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
KITCHEN SINK
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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
SETBACK
SLAB GRADE
FORMS
FOUND. REINF
REINF. STEEL
GROUT
BOND BEAM
LUMBER GR.
FRAMING
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
GARDEN WALL FINAL
PLUMBING
GROUND PLUMBING7✓7�
ROUGH PLUMB.
SEWER OR SEPTIC TANK
GAS (ROUGH)
GAS (FINAL) "(
WATER HEATER
WATER SYSTEM
FINAL INSP/2—
ELECTRICAL
UNDERGROUND
BONDING
ROUGH WIRING
METER LOOP
TEMP. POLE
SERVICE
HEATING & AIR COND.
A.C. UNIT
HEATING (ROUGH)
DUCT WORK
HEATING (FINAL)
FINAL INSP.
GRADING
FINAL INSP. /Z, 34 cu. yd.
$ plus x$
REMARKS:
I N SPE CTO WS
SOLAR
COLL. AREA
STORAGE TANK
ROCKSTORAGE
OTHER APP.IEQUIP