002876 (BLCK) IIIIIIIIIIIIIIIIIIIIIIIII 63IE
•
P.O. BOX 1504 No.
002876
Building 78-105 CALLE ESTADO
Address 79-570 Axwd P LA QUINTA,CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. OCC:GRP.
Mailing"
Address %..n1'i1; r*rw *4my As A.P. Number
City Zip Tel.
.F .92290 568-2828__ Legal Description
Contractor Project Description
Matimol Huge and ltlri
Address
City - Zip' Tela
>
State Lic. City
&Classif. 288130 Lic.# 328 Sq. Ft. No. No. Dw.
Size 1767'Ain. g stories Units
Designer New CO. Add ❑ Alter❑; Repair ❑. Demolition ❑
_ a.
Address Tel.
City Zip State
. . Lic.#
LICENSED CONTRACTOR'S DECLARATION
I hereby"affirm that Lam lidensed-under provisions of Chapter 9(commencing with,Section "
7000)of Divisio n13bf the Business and Professions Code,and my license is in full forte and +•
effect.
SIGNATURE/ V 1 /1—'o , f- DATE
wOWNER-BUILDEWDECLARATION ,
I hereby affirm that I am exempt from A Contractor's License Law for the following Estimated Valuation 44,175.00 175 00
_reason: (Sec. 7091.5,Business,and Professions Code: Any city or county•which requires a f
permit to,construct, alter, tmprove, demolish,*or repair any structure, prior to its issuance also - x-
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, of 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 penafty,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..Bdl.
do the work,and the structure isnot 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
50
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
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner or 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.
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
O Copy is filed with,the city. O Certified copy is hereby furnished.
TOTAL 432AA
t)A
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 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.
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 Minirrltim 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
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—J 0.-87
l.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 -ofthis city to enter the above
mentioned property for inspection.purposes. Validated by:
Signature ofapplicant —Date ""-S'' '•J'r _ -
Mailing Address r ' ff f f'` Validation:
City, State, Zip
A7215 1 30 43294 R
HARD COPY
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1ST FL. SO.FT.® $ UNITS
2ND FL. SO.FT.
YARD SPKLR SYSTEM
POR. SO.FT.® MOBILEHOME SVC. BAR SINK
GAR. SO.FT.® POWER OUTLET ROOF DRAINS
CAR P. SO.FT.
DRAINAGE PIPING
WALL SO.FT.® DRINKING FOUNTAIN
SO FT ® URINAL
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 LAUNDRY TRAY
AIR HANDLING UNIT CFM 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
SO.FT.®c WATER HEATER
MAX.HEATER OUTPUT,B.T.U. SO.FT.RESID®11/4 c SEWAGE DISPOSAL
SO.FT.GAR®3/a- 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 ROCK STORAGE
FOUND.REINF. GAS(ROUGH) METER LOOP HEATING(FINAL) OTHER APPJEOUIP.
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 REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL