001996 (PLBG)Building
Address
Owner
Mailing
Address
City Zip
Contractor
Address
T414f 4 QUM&
P.O. BOX 1504 N o , '
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
2253 564-446' Legal Description_
Project Description
Zip I Tel.
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer
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
Mt.
�LG NATURE DATE
OWNER -BUILDER DECLARATION
I her affirm that I am exempt from the Conirac[ar'a Llcensa Law for the following
reason: {S 0. 7031.5.Business and Professions Cade: Any city of county which raquirea a
permit to construci, alter, mrprom, demolish, or repair any sfruclure, prior to Its issuance also
inquires the applicant for such permit to Me: a signed slatemenl that he Is licensed pursuant to
the prav7&IorIL of [d8 Conlydelor's LMense Law, Chapter 9 (commencing mph Section 7000J of
Alvis+on 3 of the Business and Professions Code, or that. he Is exempt therefrom, and the deals
for The afleeyed exemption. Any YW,3flurl of Seclion 7031.5 by any applicant for a permit
subjects the applicant to a civil penally of not more than five hundred dollars ($500).
r7 I, as owner of the property, or my employees with wages as their sore compensation, will
do the work, and the structure is not intended or offered for sale. (Sec- 7"4, Bussness and
73vrassion,s Cade: The Contractor's License La* doas nol apply to art owner of property who
builds or improves thereon and who does such work himself or through his own emWoyees,
provided that such h7rprovements ale not intended or offered for sale: If, however, rho buitding
at improvement is sold wlthke me year of completion, the owner-bwlder will have the burden
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-
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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under SecB, & P.C. for this reason
Date Owner
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,
CERTIFICATE OF EXEMPTION FROM
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: 11, alter making this Cerritkald of Exemption you should become
subject to the Workers' CCmpensaliert provisions of the Labor Code, you must forthwith
comply with such provisions or this penult shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's Address
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 certify that I have read this appllcation and state that the above information is Correct.
I agree 10 comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above -
mentioned property far inspection purposes.
Signature of applicant ___ _Date
Mailing Address —
City, State, Zlp
Sq. Ft. No. No. Dw.
Size Stories Units
New .❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
COnst.
Mech.
Electrical
Plumbing
S.M.I.
Gradi rig
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR.
Issued by:
Date Permit
Validated by:
Validation:
A380%
1 9
HARD COPY
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
1ST FL SQ. FT. ®
-
2ND FL. SQ. FT. @
POR. SQ. FT- @
GAR, SQ. FT_ @
CAR P. SO. FT. @
WALL SQ. FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION
$
UNITS
YARD SPKLR SYSTEM
iMOBILEHOME SVC.
BAR SINK
POWER OUTLET
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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT OFM
KITrHFN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPHESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. 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/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
IL
TOTAL FEES
MICRO FEE
MECH.FEE
PL.CK.FEE
CONSI. 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)
DUCT WORK
STORAGE TANK
ROCK STORAGE
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
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
����
a
7 � rlN h•K
YYY
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlI N ITIALS
GARDEN WALL FINAL
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