10714 (SFD)T4ht 4 4 Q916(a,
P.O. BOX 1504 N o . 10 714
Building 78-105 CALLE ESTADO
Address - •- '_ _ _li LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address -
A-P. Number_
City
Zip
Legal Description
Project Description
`
Contractor
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
I hereby affiim 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.
5JUNATURE DATE
OWNER.BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors Licerme Law for the Following
reason: fSec. 7031.5,8uskress and Professions Code: Any city or comfy which requires a
permit to COn&ruff, allar, knprove, demolish, of rapalr any StnlcfU10. Prior to Its isauartce at96
requires the applicant for such permit to fife a signed sfarommf that he Is licensed pursuant to
the provisions of the Conireclor's License Law, ChWar 9 fcommoncfng with Section 7000) of
Estimated Valuation
PERMIT
AMOUNT
Division 3 of the Business and Pmrmai ans Code, or fhaf. he is exempt thamrmm, and the basis
for the athigad exemption. Any Pk0a9on of Section 7031-5 by -any applicant for a permit
subjects the appNcanf to a civil penalty of not more than five hundred doitars ($500).
❑ 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: fSec. 7044, Suhmess and
Professions Cade: The Contractor's Lk'ense Law does nut apply to an owner of property who
Plan Chk. Dep.
Plan Chk. Bal.
COr1St.
�? -`- �; a '-� i,
Mech.
builds or 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
Electrical
i 3 Q , 1
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not built or improve for the purpose of sale.)
Plumbing
1, as owner of the property, am exclusively contracting with licensed contractors to con-
4striuct the project. (Sec. 7044, Business and Profess ons Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
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
S.M.I.
_
Grading
Driveway Enc.
}
Date owner
Infrastructure
!f
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.)
P011cy, No., Company _
j Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
. !
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(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.
Dale Owner
NOTICE TO APPLICANT. it, altar making this Cerfllkde of Exemplior you should become
subject to the Workers' Compensation provisions of the Labor code, you must forthwith
comply with such provisions or this penrdt shall be deemed remked.
ZONE: BY:
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, 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.
1 certify (hat I have read this applicalion 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 represtrntatives of this city to enter the above•
mentloned property for inspection purposes.
Issued by:
Validated by:
Date Permit
Signature of applicant Data
Mailing Address—
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
1ST FL. SQ. FT. ®
2ND FL. SQ. FT.
POR SO. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT. @
WALL SQ. FT.
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION
$
UNITS
YARD SPKLR SYSTEM
IMOBILEHOME SVC.
BAR SINK
POWER OUTLET
I 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
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.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ Mc
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 PLUMBIN /)J
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.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE .112
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
LUMBER GR.
WATER SYSTEM
GRADING
yd.
$ plus x$
_$
FINAL INSP C7
FINAL IN 2cu.
r
FRAMING J� % G��
J c i
ROOFING
!�A
I/`,•�,
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
L HING �,5 - —O
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
r
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINTTIALS
GARDEN WALL FINAL
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