07308 (PLBG)4 4 "
P.O. BOX 1504 No, 07308
Building A-474 Herrera 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Mailing BUILDING: TYPE CONST. OCC. GRP.
Address�_4-4`4 Herrera 774—251-023
A.P. Number
City Zip JTel.
La F;'uinta 922"3 r46— Legal Description Lets 111, 14
Contractor Project Description swer "Oak up
Ecrk1O Sweer
Address
PO ;ax 192
City Zip Tel.
Valli Desert �226L3 3"t6-2791
State Lic. . City
& Classif. l(1$61 Lic. # 342 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
t herebyy affirm that I am licensed under provisions of Ghap;erg {commencing with Section
70n of ❑Ivislen 3 of the Business and Professions Code, and.my.license is in full force and
effect.t�.
PATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the contractor's License Law for the following
reason: (Sec. T03f.5,13usazes.4 and Professions Code: Any city or caunfy which requires it
permlt fo canstrrrdf, altar. improve, demCNah, or repair any structure, ptfor to Its i usnco also
requires fha applicant for such permll to file a smnod statement that he fs licensed pursuant to PERMIT AMOUNT
the provisions of the Cantraclar's License Law, Chapter 9 fcommancfng with Section 7000J of
❑/vision 3 of the Surivass and PfoteSsions Code, ar that. he is exempf therelmm, and the 'basfs
for rho alleged examprion. Any vialagon of Section 7031.5 by any appNcanf for a permit Plan Chk. Dep.
Subjects the applicanf to a end penally of net more than five hundred dollars rsan .
F,, Ias owner of the property, or my employees with wages as their sale compensation, will Plan Chk. Bal.
i do h0 work, and the structure is not intended or offered for sale. (Sec. 7044, Bwaness and COf1St.
Pmlessions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own_ employees, Mech.
provided that such improvameals are not intended or altered for safe, a. however, the bxr�lding
or ftrovemenf is sold vrill"M one year al nerrVelion, the owner -blinder wilt 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.)
❑ I am exempt under Sec. B. & P.C. for this reason —
Grading
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 SectkM deed rat be completed N the pemur is for one hundred dollars ($TOO) vafnabon
of loss.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any ppeerson in any manner so as to become subject to the Workers' Compensation
Laws of Cali omia.
Date —Owner
NOTICE TO APPLICANT: N, after makkrp this Certificate of Exemption you should become ZONE:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith BY.
comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances:
Front Setback from Center Ling,
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 Ij}FEFTPR
�l
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
I certify that I have read this application and state thal 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 autho&e representatives -of this city to enter the above•
menfioned properly for inspection purposes. Validated by:
Signature of applicant —Date—
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL
FEES
NO.
PLUMBING
FEES
$
UNITS
1ST FL. SO. FT. ®
_
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT.
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
DRAINAGE PIPING
CAR P. SQ. FT.
DRINKING FOUNTAIN
WALL SQ. FT.
URINAL
Sp. FT.
ESTIMATED CONSTRUCTION VALUATION $
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.
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/ic
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 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
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
LUMBER GR. FINAL INSP. cu. yd.
FRAMING FINAL INSP. $ plus X$ =$
ROOFING 7�} �JJyr777 REMARKS:
VENTILATION
FIRE ZONE ROOFING r
FIREPLACE ^�Iy
SPAHK AHHFSIOH
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIG NATURE51iNITIALS
GARDEN WALL FINAL
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