11681 (CP)T4ht 4 4 "
P.O. BOX 1504 No. 11681
Building 78-105 CALLE ESTADO
Address _5551_12 -11 LA QUINTA, CALIFORNIA 92253
Owner
Mailing BUILDING: TYPE CONST. OCC. GRP.
Address A.P. Number
City Zip Tel.
i1A 11it, .) a.C4 6
(:'y r r Legal Description
Contractor
Project Description -
':':l.:�a� itis ''fiC7 �
Address
7 I045 p:.1.rk b,"Lrci. Trni?
Cit Zip Tel.
9328201 31
State Lic. City
& Classif. Lic: it - - 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
effec
7000) t. of Division 3 of the Business and Professions Code, and my license is in full force and
plc"1fT'�RF DATE
OWNEWBUILDER DECLARATION Estimated Valuation ,
I hereby affirm that I am exempt from the Contractor's License Law for the following r') 0
reason; (See. 7031.5,0u0ness and Professions Cade: Any city or county which requires a
parmil to construct, alfor, kWrove, demolish, or repair any Strucfure, prior to its issuance also
rsquFres the applicant for such pamU to rite a signed statement that he is flcensad pursuant to PERMIT AMOUNT
the provlslons of the Contractors License Law, Chapter 9 (commencing with Section 7000) of
Divieon 3 of the Business and PmtesSlons Code, or that. he is exempt therefrom, and the basis
for the alfeged exempt"- Any violation of Section 703 1. 5 by any applicant far a permit Plan Chk. Dep-
sybjects the applicant to o cfv# penalty of not more than five hundred dollars (8500)-
Li I, as owner of the property, or my employees with wages as their We compensation, will Plan Chk. Bal.
do the work, and the Structure is riot intended or offered for Sale. fsec. 7044, Bulsness and Const.
lode: The Conlractor'g Lccanse Law does not eppiy to an owner of property who
buiids or rmpmves thereon and who does such work himsev or Ihrougfr his own employees, Mech.
provided that such improvements are not Intended or offered for Sala- ll, however, the btrifding
or improvement is sold within one year of campfalion, the owner-buAlder wN have fhe 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 Profasmns 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,
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec.-B & P.C. for this reason -
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
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (5100) 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 Certilicate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provlslons or the Labor Code, you must forthwith
comply with such provisions or this permit shatibe 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
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line
Lender's Name
Lender's 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.
I certify that I have read this application and state that the above informEUIM la correct- Issued by: Date Permit
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof this city to enter the above.
mentioned property for Inspecfron purposes, Validated by:
Signature of applicant pates
Mai I i ng .Address _ Validation:
City, State, Zlp
CONSTRUCTION ESTIMATE
GROUND PLUMBING
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT. @
FOR. SQ. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT ®
WALL SQ. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
SLAB GRADE
UNITS
BONDING
HEATING (ROUGH)
YARD SPKLR SYSTEM
IMOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
ROCK STORAGE
DRAINAGE PIPING
GAS (ROUGH)
DRINKING FOUNTAIN
HEATING (FINAL)
URINAL
REINF. STEEL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
SERVICE
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
WATER SYSTEM
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
LUMBER GR.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
FIREPLACE
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
GAR. FIREWALL
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
ISEWAGE DISPOSAL
MESH
SQ.FT.GAR ® 3/4c
HOUSE SEWER
INSULATION/SOUND
FINISH GRADING
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S S4GHATURE511NITIALS
GARDEN WALL FINAL