05370 (RPL)x
Building
` Address
Owner ,
Mailing
Address
77-6`]f
City, •
PALK DES=
Contractor
Address... ... ,
City. r
State Lic.
S Classif.
Arch., Engr.,
Designer
T P.O. BOX 1504. , 'No. 05370 °.
78-105 CALLE ESTADO
t tet, LA QUINTA, CALIFORNIA 9M3
BUILDING: TYPE CONST. - OCC: GRP.
T)FLAWARV A.P. Number 29?_7Ai_nT
Zip - Tel. '
92260 Legal Description
,
. Project Description -
3i32LflER ..
-t
I LiC. If
r
Sq. Ft. No.
Size - - Stories
No. Dw.•
Units. .
Address
Tel.
City
Zip
State
Lic. If
LICENSED CONTRACTOR'S DECLARATION'
1 hereby aifinn that I am licensed under provisions of Chapter 9 (commencing with Section
7nd0g0) ofof ihvrsion 3 of the Business and Professions Code, and my license is in full force and
ecL
_ S, . _ '
SIGNATURE DATE •
" OWNER -BUILDER DECLARATION
hereby affirm that I am exempt from the Contractors License Law for the following
reasort (Sec. 7031.5•8ussress and Professions Code: Any city or county which requires a
pem* to construct. after• improve, demolish, or repair any structure, prior to its issuance also
nt for such permit to fi
rawAinis me applicant a signed statement that he is licensed pursuant to
me provisions of the Contractor's License Law, Chapter 9 (commencing with Section .7000) of
4reon. 3 of the Bus -Dress and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any •violation of Section 7031.5. by 'any applicant for a permit
sutl ects the applicant to a cmYB penally or not more than rove hundred dollars (8500).
❑ 1, 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
R&essions 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,
provided that smh rrprovements are not Intended or offered for sale. If, however, the building or irprovemrent is sold within one year of completion; the owner -builder will have the burden
. of prorvg that he did not. build or vmprove for the purpose of sale.)
Estimated Valuation
- tic
PERMIT AMOUNT
' '
.
-Plan Chk. Dep.
Plan Chk. Bal. ' 5
~' Const.
AQ a '
Mech.
Electrical
Plumbing , OO
❑ I. as owner of the property, am exclusively contracting with licensed contractors to con-
-• struck the project (Sec. r 7044, Business and Professions Code: The Contractor's License Law
_
S.M,I, -
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.) -
❑ 1 am exempt under Secy B. & P.C."for.this reason '
Grading
Driveway Enc.
j 1
/
Date—x+f_f_Owner,'
/;q,
Infrastructure `
WORKERS' COMPENSATION DECLARATION
hereby affirm that l have a certificate of consent to self -insure, or a certificate of
Workers 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.
TOTALr'
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
^f .:? A ,• f
(This section need rpt be completed if the permit is for one hundred dollars (8100) valuation '
ortess_)
NYmfi Y'• a law• r, b- M v v.:.
•• '• `
1 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 70 APPLICANT: ff, after ;nakmg thie1,Vrirocate- of Exemption you, should become
S~ to the ftrkers' Compensation provisrgris-of the Labor Code; you must 'forthwith
conply With h such provisions or thspennit shall be deemed revoked.. - •
ZONE: BY:
;Minimum Setback Distances: -
Feont,Setback from Center -Line
.
Rear Setback from Rear.Prop. Line
CONSTRUCTION LENDING AGENCY
• 1 hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, C" Code.) _
Lenders Name
Side Street Setback from Center.Line
Side Setback. from Property Line -
•.. - ..
` Legs
This is a building permit when property filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days: - - •
1 certify that 1 have read this application and state that the above information is correct.
I agree tocomply with all and county ordinances and state laws relating to building •
on hereby authorize representatives' -of this city -to enter .the above-:
mentioned property for inspection purposes. .. •
FINAL DATE INSPECTOR'
. .
1
-PermiY
Issued b Datt?2Icity
- y.
v
Validated by:
Signature of applicant c Date
^
. '—ling naa
City, state, Zip
EValidation:'
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4
4,;,rly {.*._ i.,{•t"t' - .+".,., tiiTata.r. ,r„a•,y 'x a.?-... r J L,'v ay__. '.Ir".°
- as .:: a 2 . r. ;x. _ . .... . - - - - u
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+ " ,sk'.e ` r'tii,• :'.. ~ 4.a „ •h+#rt( `YN'.:.. }-, . r'r3" •4.::;' t lt:i,j t
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. Fr. ® $
UNITS
A.C. UNIT
2ND FL SQ. FT.
SLAB GRADE
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
SEWER OR SEPTIC TANK
DRAINAGE PIPING
CAR P. SQ. FT.
DUCT WORK
ROCK STORAGE
WALL SQ. FT.
AS UG /
(
DRINKING FOUNTAIN.
SQ Fr. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
REINF. STEEL
WATER PIPING
NOTE: Not to be used as property tax valuation
TEMP. POLE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
WATER SYSTEM
LAUNDRY TRAY
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. Fr. RESID ® 1% c
SEWAGE DISPOSAL
FIRE ZONE ROOFING
SQ.FT.GAR ® 3Vac
HOUSE SEWER
FIREPLACE
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
UND PLUMBING :32UNDERGROUND
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.
AS UG /
(
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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
/ / / / T /
a
$
r 1 '<REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
'
GARDEN WALL FINAL