002454 (BLCK)P.O. BOX 1504 No. 00244
Building�78-105 CALLE ESTADO
Address 7.4Q R -LA QUINTA, CALIFORNIA 92253
Owner ..
t3chn VX*
Mailing '
Address SMW
City Zip
Contractor
Address
82-231 HeUo Ct.
- City " Zip
State Lic.
& Classif.
Arch.,- Engr.,
Designer
BUILDING: TYPE CONST: OCC: GRP.
A.P. Number 617-.Ul-0 6 ,
Tel.
Legal Description's
Project Description
.. I Tel.•.
Lic. #
Sq. Ft. No.
Size - Stories
New ❑X Add ❑ Alter ❑
No. Dw.
Units -
Repair ❑
Demolition ❑
Address Tel.
City Zip State 142 "h. f.. of A b�at high WD& wan
Lic. #
LICENSED CONTRACTOR'S DECLARATION.. /%f pA fow mtvt, Vi'i,,
i
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section ^ a
7000). of Division 3 of the Business and Professions;Cod'ey , and m license Win full force and
�it1
.effect. �,`.,,r.�•,�,,E�..� w `""7""s•.,.- ..
SIGNATURES r. DATE _
f x..?OWNER•BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for lhe:following�L��tV .O
reason: (Sec. 7031.5,Business and Professions Code:. Any city or*county which requires a
permit.to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
. requires.fhe applicant for such permit to file•a signed statement that he is licensed pursuant to
PERMIT - - -
AMOUNT
the provisions of the Contractor's License Law, Chapter .9 (commencing with Section 7000) of -
Division 3 of the Business and Professions -Code, or that. he"is exempt therefrom, 'and the basis
... for the alleged exemption. Any violation of Sectlon• 7031.5. by 'any applicant for a permit
Pian Chk: Dep.. -
-subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
-
Plan Chk. Bala
O 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, Buisness and
Const.'
Professions Code: The Contractor's License Law does not•apply to an 'owner of property who .?!w_
-or
builds improves thereon and who does such work himself or through his own employees,.
provided, that' such improvements are not intended or offered for sale. If, however, the building
Mech. -
or improvement is sold within one year of completion, the owner -builder 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
- struet the project. (Sec. 7044, Business and Professions 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?
tr
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.). -
Grading
- 0. I am exempt under Sec. - B. t. 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
93.72
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 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
ZONE: --BY:
' subject to the Workers" Compensation provisions of the Labor Code, you must forthwith
complywithsuchprovisionsorthispermitshallbedeemedrevoked.
-
.Minimum Setback Distances:
-
Front Setback from Center 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 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:: Jr r
Signature,of applicant �� fi`� / Date
Mailing Address t�
city, State;' Zip
HARD COPY
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by:. Dateermit
Validated by:
Validation:
A 5 9 4 2 7 10 93.72 U
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. p $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. I SO. FT. p
WALL SO. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM,
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE. UNIT WALL FLOOR SUSPENDED
/
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
IKITCHEN 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
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR,
SQ.FT.GAR Q 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
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
ROCKSTORAGE
rr►►
AleFOUND. REINF.
/
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
a
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
d
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR,
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
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_
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
INAL INSPECTION 7/
CERT. OCC.
FENCE. FINAL ,
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GARDEN WALL FINAL
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ANt3'.A€L APPUC ES
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