9960 (PLBG)Tityl 4
` P.O. BOX 1504 No. 9960
••
Building r 78-105 CALLE ESTADO 1
Address 49-45 1 CUIJARRO LAQUINTA, CALIFORNIA 92253I
Owner
Jt)H?v'St7N
Mailing BUILDING: TYPE CONST. OCC.GRP.
Address SAME
A.P. Number
City Zip Tel.
LA QUINTA 92253 Legal Description
Contractor SEWER i:00KL'F
Project Description
ECONO SEWER
Address
P 0 60X 182
City Zip Tel.
PALM DESERT
State Lic. City
& Classif. 480961 Lic. # 342 Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Gluts
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
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. S, Rusiness and Professions Cade: Any city or eaunly which requires a
Permit to construct, after, Nnprove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such perm[[ to rr1e a signed statement that he is I"nsed pursea,nf to PERMIT AMOUNT
the provisions at the Conlraefar's License Law, Chapter 9 (commencing wrAh Section 7000) of
Division 3 of ffte Business and Professions Code, or that he is arempf therefrom, and tlta basis
for the aitaged exemplian. Any violation of Section 7037.5 by any applicant for n permit Plan Chk. Dep.
subfecW the applicant to a civil penalty or not mcfe then five hundred dollars (35001,
I, as owner of the property, or my employees with wag as as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not Intended br offered for sale. (Sec. 7044, Bulaness and COr1St.
Profeeslons Code: The Contractor's Licensa Law does not apply to an owner at properly who
builds or improves thereon and who does such work himzoff or fhrough his own employees, Mech.
Provided .that such improvements are not Intended at offered for sole, ff, however, the buRding
or Improvement is sold wlthi n one year of completion, the owner -builder wPo have the burden Electrical
of proving that he did not build or improve for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to can- Plumbing $ 30 . 00
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.1.
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. & P.C. for this reason
Driveway Eric.
Date owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
waricer's Compensation Insurance, oracle e j. 3gp0, Labor Code.)
Pellcy No. Company � ip i �' _
Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL $ 3 G . 0 0
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 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
DateOwner
NOTICE TO APPLICANT: if, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensallen provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Frans Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) Side Setback from Property Line
Lender's Name
Lender's Address - FINAL DATE INSPECTOR
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. 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 -of this city to enter the above -
mentioned property for inspection purposes, Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
1ST FL. SQ. FT. ®
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT ®
WALL SQ. FT. @
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION
$
UNITS
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
I
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
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE,TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3Vic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL TOTAL FEES MICRO FEE
MECH_FEE
PLCK.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 TAN"
r i
?&UGH
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
� 1
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESUNITIALS
GARDEN WALL FINAL