002029 (RPL)P.O. BOX 1504 No. 002029
Building 78-105 CALLE ESTADO
Address 79-540 XHbi"er-3= P4ad LA QUINTA, CALIFORNIA 92253
Owner
Mailing
BUILDING: TYPE CONST..—OCC. GRP.
Address A.P. Num_ _bef17-121-046
City ZipTel.
�. Legal Description 26
Contractor Project Description
Gls�i�x'
Address _
City. _ Zip _.. Tel:
State Lic. "�City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Size Stories - Units
Arch., Engr.;
Designer - New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION. Y 'u'
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section i
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031,5,Business and Professions Code: Any city, or county which requires a .4 •
permit to construct, alter, improve, demolish, .or repair any structure, prior to its issuance also - �•
requires the 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 Section 7031.5 by 'any applicant for a permit Plan Chk. Dep...
subjects the applicant to a civil penalty of not more than five hundred'dollars ($500), - -
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. ernA
Professions Code: The Contractor's License Law does not apply to an owner of property who..ir4
builds or improves thereonand who does such work himself or through his own employees, Mech.
provided that such improvements are not Intended or offered for sale. If, however, the building.
or improvement is sold within one year or 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 -
struct 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. _ - -� .
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.- Grading
V
r , 7', Driveway Enc.
Date Owner Y J 1`lj4'eeA t "1f'c Infrastructure
r• s
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
O Copy is filed with the city.. ❑ Certified copy is hereby furnished.
_ TOTAL .12 AA
CERTIFICATE OF EXEMPTION FROM REMARKS'
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the pe.-mit is for one 'hundred dollars ($100) valuation
or less.)
I certify that in 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' 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 Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
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. y h
I certify that I have read this application and state that the above information is correct. Issued by: Date i J Permit
I agree to comply with all city and county ordinances and state laws relating to building
construction, and herebyauthorize representatives of this city to enter the above-
mentioned property for Linspection purpo/Ifsses. Validated by:
Signature of applicant ;t�*�� X� —Date
Mailing Address AValidation:
City, State, Zip t f
(Y A4063 1 30 21290. f.
HARD COPY
CONSTRUCTION ESTIMATE
NO. , ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. p $
2ND FL. SQ. FT: ® i
POR. SO. FT. ®
GAR. SO -FT. ®
CAR P. SQ. FT:
WALL SO. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
4
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
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
'FORMS
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SEWER OR SEPTIC TANK
LAUNDRY TRAY
AIR HANDLING UNIT CFM
DUCT WORK
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.
SO. FT. ® c
BATH •TUB
TEMP. POLE
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
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. `/ Y
L ONDING
HEATING (ROUGH)
STORAGE TANK
'FORMS
SEWER OR SEPTIC TANK
TROUGH WIRING j ��
It
DUCT WORK
ROCK STORAGE
, FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
L
�REINF. STEEL G 21/
,�O
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
iSERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING /( "c [
v lv
FINAL INSP.
'ROOFING
Qj
�! DEC 17
7
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
S.
' INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS, •
GARDEN WALL FINAL