001773 (PLBG)Building
5-3-11_
Address
Owner
RUM
! Mailing
Address
82-21
City
& Classif.
Trgi tt
Contractor
No. No. Dw.
_ Address..
.
I is 4E:i' Dive
i SdLmo AV--.
Zip Tel.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. 001773
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description
- :..City ..
Zip..
Tela _
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
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
f
effect.
SIGNATURE DATE
_
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
M
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
`"•
-AMOUNT
requires the applicant for such permit to file a signed statement .that he is. licensed pursuant to
.-PERMIT '
- -
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
"Plan
'
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). -
Plan Chk.. Bal.
-
❑ 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
'
.
• builds or improves thereon and 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 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
- 12.00
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.I.
-
- such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) + - -
!:
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
r
Date owner •-+ %+ ,- 1-- r - -
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. (Seca 3800, Labor Code.)
-
Policy -No. - .Company
q Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
12.00
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.) _
_.
1 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
comply with such provisions or this permit shall be 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
I hereby affirm that there is a construction lending agency for the performance of the
'
work for which this permit is issued. (Sec. 3097, Civi/ 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 certifythat I have this '.the
Permit
read application and state thatabove information is correct.
Issued by-
Date
I agree to comply with all city and county ordinances and state laws relating to building
j.
construction, and hereby authorize representatives -of this. city to' enter the above-
mentioned property for inspection purposes. J
Validated by:
Signature of applicant S Vit- '�-' Date
Mailing Address %' • L '
Validation.
-
City, State, Zip
A 3 0 4 8
10 3U 1.20'0 a
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. p
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
WALL SQ. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
SQ. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
_$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
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
INSULATIONISOUND
GRADING
/FINISH
(7 FINAL INSPECTION ZJ
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL